Antimicrobial resistance and antimicrobial therapy modification during COVID-19 pandemic in large tertiary hospital.

Objective. assessment of the evolution of the microbiological landscape of the hospital for the period of operation in 2020 into a pandemic of a new coronavirus infection in various departments, including intensive care units;change depending on the results of antibacterial therapy regimens. Materials and methods. In a retrospective study, conducted from June to December 2020, in a multidisciplinary hospital working with COVID-19 infection, the resistance of isolated strains of microorganisms was analyzed in patients of different age groups. Resistance was assessed with test points in June and November 2020;depending on this, proposals were made to correct the internal (local) protocols of antimicrobial therapy. Results. The need for frequent and regular microbiological monitoring was confirmed. Further, we understood that the territories of the main and temporary hospital of the City Clinical Hospital No. 40 are heterogeneous and there are obvious differences both in structure and in the level of sensitivity. "In practice, these are two different hospitals". Within the territories, the branches also differ from each other. When analyzing resistance in ICUs, it was revealed that within each hospital in each department, albeit similar in structure and profile of patients, there is a different level of resistance of strains. Conclusions. The structure of sensitivity generally corresponds to the world data, but for some pathogens it differs significantly. Microbiological monitoring should be carried out not only inside the hospital, but also inside the department. The increase in consumption of carbapenems and protected cephalosporins requires a reassessment of the practice of using AMP in any covid hospital, due to the impact on the epidemic situation both in the ICUs and in the hospital.Copyright © 2021, Interregional Association for Clinical Microbiology and Antimicrobial Chemotherapy. All rights reserved.

Immunohistochemical profile of cell cycle control, proliferation and differentiation proteins of the pulmonary atypical alveolar epithelium with COVID-19-induced diffuse alveolar damage as compared to pulmonary [lepidic-growth] adenocarcinoma.

We aim aim to compare immunophenotypic charac-teritics of atypical epithelium (AE) with COVID-19-induced diffuse alveolar damage (DAD) and pulmonary lepidic-growth adenocarcinoma, accounting for cell cycle control, proliferation and differentiation]. Methods. We examined pulmonary tissue specimens from twenty-four fatal cases of CO VID-19-induced acute respiratory damage syndrome confirmed by autopsy (Group 1) and four cases of pulmonary lepidic-growth adenocarcinoma (Group 2). Perpendicular dimensions of 10 nuclei were measured on the H&E slides, means of their sums of products (SPNM) were calculated. We have used p53, Ki67, pi6, p63 antibodies for immunohistochemical staining in each case. We evaluate colour intensity, rate of stained cells of AE and the product of these parameters. We evaluated separately Nuclear and cyto-plasmic staining (couple) and only cytoplasmic staining (cyt) for pi6 expression. We measured proliferative index only at KI-67 stained slides. U-test and Spearman rank correlation test were used for statistical analysis. Results. Expression of p63 was higher in group 1 (p=0.001), while pi6 was more frequently expressed in group 2 (p=0.002). We have found no statistically significant differences (p>0.1) in the p53 and Ki67 expression. Group 1 showed There was negative correlation between the number of days from onset of symptoms and the following variables: Ki67 (r=M).587, p=0.003);SPNM (r 0.406, p=0.049). Conclusion. The present study has shown heterogeneity in levels of cell cycle control expression, proliferation and differentiation of atypical epithelium in the pulmonary lep-idic-growth adenocarcinoma and CO VID-19-induced diffuse alveolar damage.Copyright © 2022 Izdatel'stvo Meditsina. All rights reserved.

[The impact of BMI on the course of the acute SARS-COV-2 infection and the risks that emerge during the first year after the hospital discharge. Subanalysis evidence of the AKTIV and AKTIV 2 registries].

BACKGROUND: There is enough evidence of the negative impact of excess weight on the formation and progression of res piratory pathology. Given the continuing SARS-CoV-2 pandemic, it is relevant to determine the relationship between body mass index (BMI) and the clinical features of the novel coronavirus infection (NCI). AIM: To study the effect of BMI on the course of the acute SARS-COV-2 infection and the post-covid period. MATERIALS AND METHODS: AKTIV and AKTIV 2 are multicenter non-interventional real-world registers. The АКТИВ registry (n=6396) includes non-overlapping outpatient and inpatient arms with 6 visits in each. The АКТИВ 2 registry (n=2968) collected  the  data  of  hospitalized  patients  and  included  3  visits.  All  subjects  were  divided  into  3  groups:  not  overweight  (n=2139), overweight (n=2931) and obese (n=2666). RESULTS: A higher BMI was significantly associated with a more severe course of the infection in the form of acute kidney injury (p=0.018), cytokine storm (p<0.001), serum C-reactive protein over 100 mg/l (p<0.001), and the need for targeted therapy (p<0.001) in the hospitalized patients. Obesity increased the odds of myocarditis by 1,84 times (95% confidence interval [CI]: 1,13-3,00) and the need for anticytokine therapy by 1,7 times (95% CI: 1,30-2,30).The  patients  with  the  1st  and  2nd  degree  obesity,  undergoing  the  inpatient  treatment,  tended  to  have  a  higher  probability  of  a  mortality  rate.  While  in  case  of  morbid  obesity  patients  this  tendency  is  the  most  significant  (odds  ratio  -  1,78; 95% CI: 1,13-2,70). At the same time, the patients whose chronical diseases first appeared after the convalescence period, and those who had certain complaints missing before SARS-CoV-2 infection, more often had BMI of more than 30 kg/m2 (p<0,001).Additionally, the odds of death increased by 2,23 times (95% CI: 1,05-4,72) within 3 months after recovery in obese people over the age of 60 yearsCONCLUSION.  Overweight  and/or  obesity  is  a  significant  risk  factor  for severe  course  of  the  new  coronavirus  infection  and  the associated cardiovascular and kidney damage Overweight people and patients with the 1st and 2nd degree obesity tend to have a high risk of death of SARS-CoV-2 infection in both acute and post-covid periods. On top of that, in case of morbid obesity patients this tendency is statistically significant. Normalization of body weight is a strategic objective of modern medicine and can contribute to prevention of respiratory conditions, severe course and complications of the new coronavirus infection.

Immunohistochemical profile of cell cycle control, proliferation and differentiation proteins of the pulmonary atypical alveolar epithelium with COVID-19-induced diffuse alveolar damage as compared to pulmonary [lepidic-growth] adenocarcinoma

We aim aim to compare immunophenotypic charac-teritics of atypical epithelium (AE) with COVID-19-induced diffuse alveolar damage (DAD) and pulmonary lepidic-growth adenocarcinoma, accounting for cell cycle control, proliferation and differentiation]. Methods. We examined pulmonary tissue specimens from twenty-four fatal cases of CO VID-19-induced acute respiratory damage syndrome confirmed by autopsy (Group 1) and four cases of pulmonary lepidic-growth adenocarcinoma (Group 2). Perpendicular dimensions of 10 nuclei were measured on the H&E slides, means of their sums of products (SPNM) were calculated. We have used p53, Ki67, pi6, p63 antibodies for immunohistochemical staining in each case. We evaluate co¬lour intensity, rate of stained cells of AE and the product of these parameters. We evaluated separately Nuclear and cyto-plasmic staining (couple) and only cytoplasmic staining (cyt) for pi6 expression. We measured proliferative index only at KI-67 stained slides. U-test and Spearman rank correlation test were used for statistical analysis. Results. Expression of p63 was higher in group 1 (p=0.001), while pi6 was more frequently expressed in group 2 (p=0.002). We have found no statistically significant differences (p>0.1) in the p53 and Ki67 expression. Group 1 showed There was negative correlation between the number of days from onset of symptoms and the following variables: Ki67 (r=M).587, p=0.003);SPNM (r 0.406, p=0.049). Conclusion. The present study has shown heterogeneity in levels of cell cycle control expression, proliferation and differentiation of atypical epithelium in the pulmonary lep-idic-growth adenocarcinoma and CO VID-19-induced diffuse alveolar damage.

Clinical and epidemiological characteristics of hospitalized patients with COVID-19 during different pandemic periods in Moscow

Background. The incidence of COVID-19 novel coronavirus infection has a wave-like pattern with surges in new cases followed by declines. Viral mutations, changes in viral properties, and new strains continue to emerge and are regularly reported. The aim of the study is to present a comparative analysis of clinical and epidemiological characteristics of hospitalized patients with COVID-19 during different periods of the coronavirus infection pandemic in Moscow. Materials and methods. A two-center, retrospective observational epidemiological study was performed using medical records of patients hospitalized with the confirmed diagnosis of COVID-19 in Moscow from March 2020 to March 2022 (34,354 patients). Results. Within 2 years of the pandemic, there were significant differences in the age structure of hospitalized patients. During the early months (March–June 2020) of the pandemic, age groups of 18–45 and 46–65 year-olds accounted for higher percentages of hospitalizations. Later on (July 2020 – February 2021), the proportion of older age groups demonstrated an upward trend. From spring 2021 (the emergence of the SARS-CoV-2 delta strain) to March 2022 (dominance of the omicron strain), the proportion of hospitalized working-age adults increased once again. The proportion of severe and critically severe cases among the patients hospitalized during different periods remained at steady levels: 7.7% (6.6–8.8%) and 5.5% (4.4–6.6%), respectively. The highest death rates were observed during the delta strain surge, while the lowest death rates were reported for the omicron strain. Throughout the pandemic, the older age and chronic diseases remained risk factors contributing to the severity of the disease and adverse outcomes. Conclusion. The emergence of new variants of SARS-CoV-2 causing a shift of the need for hospitalization towards younger age groups, the persistent high rates of severe cases and death rates among people of retirement age are pressing for the unfailing readiness for implementing preventive and epidemic control measures focusing on the above groups of population. © 2022, Central Research Institute for Epidemiology. All rights reserved.

[Features of the cell composition of inflammatory infiltrate in different phases of diffuse alveolar lung damage with COVID-19]. / Osobennosti kletochnogo sostava vospalitel'nogo infil'trata v raznye fazy diffuznogo al'veolyarnogo povrezhdeniya legkikh pri COVID-19.

BACKGROUND: Acute respiratory distress syndrome (ARDS) with COVID-19 has a worse prognosis than ARDS with other diseases. Mortality from ARDS with COVID-19 is 26.0 - 61.5%, and due to other causes - 35.3-37.2%. OBJECTIVE: To find of the correlation between polymorphonuclear leukocytes (PMNs), lymphocytes, and macrophages in the cellular composition of the inflammatory infiltrate at different stages and phases of diffuse alveolar damage (DAD) with COVID-19, analyzing the autopsy material. MATERIAL AND METHODS: The lung tissue of 25 patients who died from ARDS with COVID-19 without a secondary bacterial or mycotic infection, another thanatologically significant pathology of the lungs, was studied. To study the cellular composition of the inflammatory infiltrate and the dynamics of its changes a double immunohistochemical analysis of the expression of antibodies to CD15, CD3, and CD68 was used. RESULTS: The inflammatory infiltrate and intraalveolar exudate in the exudative phase of DAD was represented by 56.8% of PMNs (CD15-positive cells; hereinafter - the average value of the percentage of positive cells to the total number of cells of the inflammatory infiltrate), 6.9% - lymphocytes (CD3-positive cells) and 19.5% macrophages (CD68-positive cells). In the early stage of the proliferative phase: 14.1% PMNs, 38.7% lymphocytes and 13.5% macrophages. In the late stage of the proliferative phase: 11.3% PMNs, 14.5% lymphocytes and 39.3% macrophages. CONCLUSIONS: In the exudative phase of DAD a statistically significant predominance of PMN was revealed, which could determine the main volume of lung damage and the severity of ARDS with COVID-19. In the early stage of the proliferative phase of DAD, a statistically significant change in the composition of the inflammatory infiltrate was revealed to compare with the exudative phase: a significant decrease in the content of PMNs relative to the total number of cells in the inflammatory infiltrate; an increase in the number of lymphocytes, which is probably associated with the start of organization and repair processes. In the late stage of the proliferative phase of DAD, compared with its early stage, was revealed a statistically significant increase in the number of macrophages in ratio.

[ACTIV SARS-CoV-2 registry (Analysis of Chronic Non-infectious Diseases Dynamics After COVID-19 Infection in Adult Patients). Assessment of impact of combined original comorbid diseases in patients with COVID-19 on the prognosis].

AIM: Study the impact of various combinations of comorbid original diseases in patients infected with COVID-19 later on the disease progression and outcomes of the new coronavirus infection. MATERIALS AND METHODS: The ACTIV registry was created on the Eurasian Association of Therapists initiative. 5,808 patients have been included in the registry: men and women with COVID-19 treated at hospital or at home. CLINICALTRIALS: gov ID NCT04492384. RESULTS: Most patients with COVID-19 have original comorbid diseases (oCDs). Polymorbidity assessed by way of simple counting of oCDs is an independent factor in negative outcomes of COVID-19. Search for most frequent combinations of 2, 3 and 4 oCDs has revealed absolute domination of cardiovascular diseases (all possible variants). The most unfavorable combination of 2 oCDs includes atrial hypertension (AH) and chronic heart failure (CHF). The most unfavorable combination of 3 oCDs includes AH, coronary heart disease (CHD) and CHF; the worst combination of 4 oCDs includes AH, CHD, CHF and diabetes mellitus. Such combinations increased the risk of lethal outcomes 3.963, 4.082 and 4.215 times respectively. CONCLUSION: Polymorbidity determined by way of simple counting of diseases may be estimated as a factor in the lethal outcome risk in the acute phase of COVID-19 in real practice. Most frequent combinations of 2, 3 and 4 diseases in patients with COVID-19 primarily include cardiovascular diseases (AH, CHD and CHF), diabetes mellitus and obesity. Combinations of such diseases increase the COVID-19 lethal outcome risk.

Antimicrobial resistance and antimicrobial therapy modification during COVID-19 pandemic in large tertiary hospital

Objective. assessment of the evolution of the microbiological landscape of the hospital for the period of operation in 2020 into a pandemic of a new coronavirus infection in various departments, including intensive care units;change depending on the results of antibacterial therapy regimens. Materials and methods. In a retrospective study, conducted from June to December 2020, in a multidisciplinary hospital working with COVID-19 infection, the resistance of isolated strains of microorganisms was analyzed in patients of different age groups. Resistance was assessed with test points in June and November 2020;depending on this, proposals were made to correct the internal (local) protocols of antimicrobial therapy. Results. The need for frequent and regular microbiological monitoring was confirmed. Further, we understood that the territories of the main and temporary hospital of the City Clinical Hospital No. 40 are heterogeneous and there are obvious differences both in structure and in the level of sensitivity. “In practice, these are two different hospitals”. Within the territories, the branches also differ from each other. When analyzing resistance in ICUs, it was revealed that within each hospital in each department, albeit similar in structure and profile of patients, there is a different level of resistance of strains. Conclusions. The structure of sensitivity generally corresponds to the world data, but for some pathogens it differs significantly. Microbiological monitoring should be carried out not only inside the hospital, but also inside the department. The increase in consumption of carbapenems and protected cephalosporins requires a reassessment of the practice of using AMP in any covid hospital, due to the impact on the epidemic situation both in the ICUs and in the hospital. © 2021, Interregional Association for Clinical Microbiology and Antimicrobial Chemotherapy. All rights reserved.

Respiratory support in COVID-19 patients in Kommunarka hospital: a single-centered, retrospective study

Introduction. During the SARS-CoV-2 pandemic, worldwide healthcare system faced a new, insufficiently investigated, fast-spreading disease with multisystem failure and relatively high amount of severe diseased. Existing evidence base needs to be frequently revisited after data accumulation and analysis. Experience of dedicated COVID-19 centers should be summarized and implicated in clinical practice according to evidence-based principles, extensive clinical trial initiation. Objectives. To investigate baseline characteristics and treatment outcomes of patients with severe SARS-CoV-2 infection course, requiring respiratory support in the critical care settings of dedicated hospital. Materials and methods. In single-center retrospective study retrospective data collection of 451 respiratory support for COVID-19 related acute respiratory distress syndrome cases (noninvasive ventilation, mechanical ventilation) in intensive care unit patients for a 5-month period performed. The analysis aimed on demographic, clinical data, disease severity scores, respiratory support parameters and modality, continuous renal replacement therapy utilization and interleukin-6 receptor blockers administration, survival rates. Results. Respiratory support required 48.8 % of intensive care unit patients, the population was demographically balanced, Charlson Comorbidity Index was 4.46 ± 2.6 and was higher in the mechanically ventilated group. 30-day survival rate (all respiratory support cases) was 33.7 %, mortality structure analysis performed. The disease severity scores, respiratory mechanics among patients in dependence of respiratory support mode and during the period of case registration analysed as well. Median static respiratory compliance at the point of initiation of invasive mechanically ventilation was 43 (IQR 35–51). Mortality in the volume controlled mechanically ventilated group was higher. Conclusions. The patients, requiring respiratory support, during intensive care unit stay have high comorbidity levels. Indications for non-invasive ventilation may be extended on patients with lower Charlson index and initial SOFA score, however, early recognition of high risk of noninvasive ventilation failure required. Volume control invasive ventilation associated with higher mortality levels despite comparable disease severity scores. Further investigation required. © 2021, Practical Medicine Publishing House LLC. All rights reserved.

Analysis of influence of background therapy for comorbidities in the period before infection on the risk of the lethal COVID outcome. Data from the international ACTIV SARS-CoV-2 registry («Analysis of chronic non-infectious diseases dynamics after COVID-19 infection in adult patients SARS-CoV-2¼).

Aim      To study the effect of regular drug therapy for cardiovascular and other diseases preceding the COVID-19 infection on severity and outcome of COVID-19 based on data of the ACTIVE (Analysis of dynamics of Comorbidities in paTIents who surVived SARS-CoV-2 infEction) registry.Material and methods  The ACTIVE registry was created at the initiative of the Eurasian Association of Therapists. The registry includes 5 808 male and female patients diagnosed with COVID-19 treated in a hospital or at home with a due protection of patients' privacy (data of nasal and throat smears; antibody titer; typical CT imaging features). The register territory included 7 countries: the Russian Federation, the Republic of Armenia, the Republic of Belarus, the Republic of Kazakhstan, the Kyrgyz Republic, the Republic of Moldova, and the Republic of Uzbekistan. The registry design: a closed, multicenter registry with two nonoverlapping arms (outpatient arm and in-patient arm). The registry scheduled 6 visits, 3 in-person visits during the acute period and 3 virtual visits (telephone calls) at 3, 6, and 12 mos. Patient enrollment started on June 29, 2020 and was completed on October 29, 2020. The registry completion is scheduled for October 29, 2022. The registry ID: ClinicalTrials.gov: NCT04492384. In this fragment of the study of registry data, the work group analyzed the effect of therapy for comorbidities at baseline on severity and outcomes of the novel coronavirus infection. The study population included only the patients who took their medicines on a regular basis while the comparison population consisted of noncompliant patients (irregular drug intake or not taking drugs at all despite indications for the treatment).Results The analysis of the ACTIVE registry database included 5808 patients. The vast majority of patients with COVID-19 had comorbidities with prevalence of cardiovascular diseases. Medicines used for the treatment of COVID-19 comorbidities influenced the course of the infectious disease in different ways. A lower risk of fatal outcome was associated with the statin treatment in patients with ischemic heart disease (IHD); with angiotensin-converting enzyme inhibitors (ACEI)/angiotensin receptor antagonists and with beta-blockers in patients with IHD, arterial hypertension, chronic heart failure (CHF), and atrial fibrillation; with oral anticoagulants (OAC), primarily direct OAC, clopidogrel/prasugrel/ticagrelor in patients with IHD; with oral antihyperglycemic therapy in patients with type 2 diabetes mellitus (DM); and with long-acting insulins in patients with type 1 DM. A higher risk of fatal outcome was associated with the spironolactone treatment in patients with CHF and with inhaled corticosteroids (iCS) in patients with chronic obstructive pulmonary disease (COPD).Conclusion      In the epoch of COVID-19 pandemic, a lower risk of severe course of the coronavirus infection was observed for patients with chronic noninfectious comorbidities highly compliant with the base treatment of the comorbidity.

International register “dynamics analysis of comorbidities in sars-cov-2 survivors” (Aktiv sars-cov-2): Analysis of predictors of short-term adverse outcomes in covid-19

The international AKTIV register presents a detailed description of out-and inpatients with COVID-19 in the Eurasian region. It was found that hospitalized patients had more comorbidities. In addition, these patients were older and there were more men than among outpatients. Among the traditional risk factors, obesity and hypertension had a significant negative effect on prognosis, which was more significant for patients 60 years of age and older. Among comorbidities, CVDs had the maximum negative effect on prognosis, and this effect was more significant for patients 60 years of age and older. Among other comorbidities, type 2 and 1 diabetes, chronic kidney disease, chronic obstructive pulmonary disease, cancer and anemia had a negative impact on the prognosis. This effect was also more significant (with the exception of type 1 diabetes) for patients 60 years and older. The death risk in patients with COVID-19 depended on the severity and type of multimorbidity. Clusters of diseases typical for deceased patients were identified and their impact on prognosis was determined. The most unfavorable was a cluster of 4 diseases, including hypertension, coronary artery disease, heart failure, and diabetes mellitus. The data obtained should be taken into account when planning measures for prevention (vaccination priority groups), treatment and rehabilitation of COVID-19 survivors.

International register “dynamics analysis of comorbidities in sars-cov-2 survivors” (Aktiv) and the register “analysis of hospitalizations of comorbid patients infected during the second wave of sars-cov-2 outbreak” (aktiv 2)

The organizer of the registers “Dynamics analysis of comorbidities in SARS-CoV-2 survivors” (AKTIV) and “Analysis of hospitalizations of comorbid patients infected during the second wave of SARS-CoV-2 outbreak” (AKTIV 2) is the Eurasian Association of Therapists (EAT). Currently, there are no clinical registries in the Eurasian region designed to collect and analyze information on long-term outcomes of COVID-19 survivors with comorbid conditions. The aim of the register is to assess the impact of a novel coronavirus infection on long-term course of chronic non-communicable diseases 3, 6, 12 months after recovery, as well as to obtain information on the effect of comorbidity on the severity of COVID-19. Analysis of hospitalized patients of a possible second wave is planned for register “AKTIV 2”. To achieve this goal, the register will include men and women over 18 years of age diagnosed with COVID-19 who are treated in a hospital or in outpatient basis. The register includes 25 centers in 5 federal districts of the Russian Federation, centers in the Republic of Armenia, the Republic of Kazakhstan, the Republic of Kyrgyzstan, the Republic of Belarus, the Republic of Moldova, and the Republic of Uzbekistan. The estimated capacity of the register is 5400 patients.

Efficacy and safety of oral anticoagulants in the treatment of covid-19

Coagulopathy and associated thrombotic complications are common conditions seen in COVID-19. There-fore, anticoagulants are an integral part of the treatment of patients with COVID-19. The aim of the study was to compare the efficacy of oral anticoagulants and low molecular weight heparins in the prevention of pulmonary embolism and their safety in terms of major bleeding incidence, as well as to evaluate the cost-effectiveness of using oral anticoagulants in the treatment of COVID-19. Materials and methods. Two stages of patient management were compared: before and after the start of a widespread use of oral anticoagulants (OAC). The incidence of pulmonary embolism and gastrointestinal bleeding during the compared time periods was analyzed to assess the efficacy and safety of anticoagulants. To assess the cost-effectiveness, we compared the cost of anticoagulants per day of treatment and per patient. Results. The incidence of pulmonary embolism and gastrointestinal bleeding did not differ during the compared time periods. Despite the increased frequency of anticoagulant use, the costs per day of treatment and per patient decreased after the start of a widespread use of OACs. Conclusion. According to the results of the study, inclusion of OACs in COVID-19 management protocols allows to reduce treatment costs without compromising its efficacy and safety. However, the short period of comparison does not allow drawing any firm conclusions. Additional large-scale comparative studies are needed.

Use of monoclonal antibodies to IL-6 in patients with severe COVID-19

The use of monoclonal antibodies against interleukin-6 (IL-6) receptors is considered as a potential method of treatment and prevention of complications of the new coronavirus infection 2019 (COVID-19), based on reducing the intensity of the cytokine storm. The aim. To assess the relationship between the use of IL-6 blockers and the risk of tracheal intubation in patients with severe pneumonia associated with COVID-19. Methods. The retrospective cohort study included patients over 18 years of age admitted to the intensive care unit (ICU) with confirmed COVID-19 infection, lung tissue damage of at least 25% between November 4, 2020 and December 25, 2020. All patients underwent standard therapy in accordance with the current recommendations of the Ministry of Health of the Russian Federation, including IL-6 blockers in some patients. The primary endpoint was tracheal intubation and initiation of mechanical ventilation (MV). Data on the use of IL-6 inhibitors, baseline demographic, clinical and laboratory characteristics, as well as information on tracheal intubation, fatal outcomes and length of hospitalization were obtained from the unified medical information and analytical system of the city of Moscow. To analyze the relationship between the use of IL-6 blockers and endpoints adjusted for baseline characteristics, a multivariate Cox proportional hazards model was used. Results. The study included 242 patients, in 120 (49.5%) of them IL-6 blockers were used. The independent predictors of tracheal intubation were the degree of lung tissue damage, ferritin and diabetes, while the use of IL-6 blockers was not associated with a decrease in the risk of intubation: hazard ratio (HR) 0.96 (95% confidence interval [CI] 0.63 – 1.48) and death: HR 1.05 (95% CI 0.69 – 1.62). Subgroup analysis showed that, among surviving patients, the use of IL-6 blockers was associated with an average decrease in hospital stay by 3 days (95% CI 1 – 6 days). Conclusion. The use of IL-6 blockers was not associated with a decrease in the risk of tracheal intubation or death. Among surviving patients, the use of IL-6 blockers was associated with a decrease in the length of hospital stay. These findings may contribute to medical decision making during COVID-19 pandemic associated high hospital workload. © 2021 Medical Education. All rights reserved.

One hundred questionnaires from repurposed hospitals: With what forces and means did we fight the «second wave» of covid-19?

In November-December 2020, the Federation of Anesthesiologists and Reanimatologists has conducted a survey of intensive care units (ICU) in 100 hospitals re-profiled for the treatment of COVID-19. There were regional (n=44), city (n=31), district (n=13), inter-district (n=8) and federal (n=4) hospitals from 27 constituent entities of the Russian Federation. Capacity of 59 hospitals was less than 300 beds, 23 hospitals — over 500 beds, 18 hospitals — 300—500 beds. The number of ICU beds exceeded 10% of repurposed beds in 35 hospitals, 5—10% of ICU beds — in 51 hospitals, less than 5% — in 14 hospitals. There were 6—12 patients per one physician in 68 ICUs, less than 6 patients — in 12 ICUs, over 12 patients — in 20 ICUs. Also, there were 3-6 patients per a nurse in 69 ICUs, less than 3 patients — in 2 ICUs, over 6 patients — in 29 ICUs. Over 70% of the repurposed beds were provided with a networked oxygen supply in 61 hospitals, 50—70% — in 25 hospitals, less than 50% — in 14 hospitals. Oxygen flow rate over 10 l/min was provided in 70 hospitals, 5—10 l/min — in 28 hospitals, less than 5 l/min — in 2 hospitals. Over 80% of ICU beds are equipped with ventilators in 78 hospitals, 50—80% — in 15 hospitals, less than 50% — in 7 hospitals. Less than 5% of ventilators have been out of order throughout the pandemic in 62 ICUs, 5—10% — in 20 departments, over 10% — in 18 ICUs. High-flow oxygen therapy was not available in 48 ICUs, ultrasound — in 10 ICUs. ECMO was available only in 17 ICUs. If we consider the pandemic as a model of health system response to non-standard global challenges, these data are essential for critical analysis despite small sample size. © 2021, Media Sphera Publishing Group. All rights reserved.

Replacement renal therapy in the treatment of patients with a severe course of the new coronavirus infection

Objective: To study the use of RRT methods and their influence on the results of treatment of patients with severe COVID-19. Subjects and methods. We retrospectively analyzed the data of 283 patients with COVID-19 in the intensive care units of Moscow City Hospital no. 40 in 2020 who had received RRT as one of the treatment methods. Results. Frequency of RRT in COVID-19 patients in ICU of Moscow City Hospital no. 40 for 2020 made 5.7% (504 out of 8.711 patients treated in ICU received RRT). In 86% of cases, RRT was performed for renal indications. At the time of initiation of RRT, the studied groups did not differ according to SOFA score. The frequency of using dialysis units with high and low cut-off point in the groups of survived and deceased patients differed significantly. The surgery itself started at relatively the same time from the onset and statistically significantly earlier in the group of survivors from the beginning of tracheal intubation (4.9 0.5 vs 6.8 0.3 days, p = 0.0013). Against the background of ongoing therapy, overall severity of the state progressed in the group of deceased patients to 9.9 0.2 SOFA scores, while in the group of survivors there was an improvement to 6.1 0.4 scores. © 2020 Geocarrefour. All rights reserved.

NEWS2 score in the practice of infectious diseases hospital in COVID-19 patients. Implementation and results

Amidst the new COVID-19 pandemic, there is a need for a reliable medical tool to monitor patients' vital conditions with clinical information continuity. This tool is essential for timely detection of the risk of the patient's clinical state deterioration throughout all the stages of medical assistance. The objective is to assess results of the NEWS2 score implementation at the in-patient stage of medical care. Methods. 183,732 scores of the NEWS2 score in 10,290 hospitalized patients were analyzed. All the assessed results of the NEWS2 score were retrospectively analyzed. The NEWS2 score results were added to the United Medical Information and Analytical System of Moscow (EMIAS) database through the NEWS2 mobile application. The researchers analyzed the descriptive statistics of the score;the prognostic significance of NEWS2 in the prediction of the disease outcome was assessed as well as the accuracy of the used methods. Results. As the result of the research, deviations from standard methods in the application of the NEWS2 score were outlined, which allowed the researchers to develop the corrective measures. The received data confirmed that interval assessment by the NEWS2 score and the trend analysis were important when making clinical and organizational decisions. Specific parameters of the score use during the COVID-19 pandemic were outlined, which helped to adjust the in-hospital procedures for clinical decision-making process, routing, and the continuity of all stages of medical assistance was established. Conclusion. The use of the NEWS2 score in medical practice makes it possible to predict the risks of clinical deterioration in the patient's condition, conduct bedside monitoring of therapy effectiveness, and optimize in-hospital routing. However, to ensure the validity of the score, it is necessary to plan activities for the personnel training and motivation, as well as to monitor careful adherence to the protocol. © 2021 New Terra Publishing House. All rights reserved.

INTERNATIONAL REGISTER “DYNAMICS ANALYSIS OF COMORBIDITIES IN SARS-COV-2 SURVIVORS” (AKTIV SARS-COV-2): ANALYSIS OF 1,000 PATIENTS

COVID-19 is a severe infection with high mortality. The concept of the disease has been shaped to a greater extent on the basis of large registers from the USA, Spain, Italy, and China. However, there is no information on the disease characteristics in Caucasian patients. Therefore, we created an international register with the estimated capacity of 5,000 patients - Dynamics Analysis of Comorbidities in SARS-CoV-2 Survivors (AKTIV SARS-CoV-2), which brought together professionals from the Russian Federation, Republic of Armenia, Republic of Kazakhstan, and Kyrgyz Republic. The article presents the first analysis of the register involving 1,003 patients. It was shown that the most significant difference of the Caucasian population was the higher effect of multimorbidity on the mortality risk vs other registers. More pronounced effect on mortality of such diseases as diabetes, obesity, hypertension, chronic kidney disease, and age over 60 years was also revealed. COVID-19 - тяжелое инфекционное заболевание с высоким риском летального исхода. Представление о болезни во многом сформировано на основании крупных регистров, выполненных в США, Испании, Италии, КНР. Однако к настоящему времени нет данных по особенностям протекания болезни у пациентов евроазиатского региона. В связи с этим был создан международный регистр, расчетная мощность которого составляет 5000 пациентов, “Анализ динамики Коморбидных заболеваний у пациенТов, перенесшИх инфицироВание SARS-CoV-2” (AКТИВ SARS-CoV-2), работа в котором объединила специалистов Российской Федерации, Республики Армения, Республики Казахстан и Кыргызской Республики. В статье представлен первый анализ регистра, который включил данные 1003 пациентов. Показано, что самым значимым отличием евроазиатской популяции пациентов оказалось гораздо большее влияние полиморбидности на риск летального исхода в сравнении с другими регистрами, а также более выраженное влияние на риск летального исхода в евроазиатской популяции таких заболеваний, как сахарный диабет, ожирение, артериальная гипертензия, хроническая болезнь почек и возраста старше 60 лет.

[International register "Analysis of Chronic Non-infectious Diseases Dynamics After COVID-19 Infection in Adult Patients (ACTIV SARS-CoV-2)"]

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Psychological state of medical staff throughout the COVID-19 pandemic

COVID-19 affects all aspects of social life, including mental health. Some authors reported an increased risk of suicides. Objective. To assess the psychological state including anxiety, depression, and mental burnout in medical staff who works with new COVID-19 infection. Material and methods. An anonymous research was conducted in Moscow COVID-19 departments in June 2020. The study included 470 respondents who work with COVID-19 infection including 323 physicians and 147 nurses. Physicians included 274 anesthesiologists and intensive care specialists and 49 doctors of other specialties. We have used the following scales: Beck Depression Inventory, Maslach Burnout Inventory scale (MBI) for physicians adapted by N.E. Vodopyanova (emotional exhaustion (EE), depersonalization (DP), reduction of professional achievements (PA)), State-Trait Anxiety Inventory (STAI), Beck Hopelessness Inventory for assessment of negative attitude to subjective future. Additional questions: subjective assessment of fatigue throughout a week, subjective assessment of efficiency, somatic complaints over the past month. R-Studio software (Version 1.0.153 2009-2017) was used for statistical analysis. Results. Depression was observed in 67.8% of physicians and 59.18% of nurses, negative attitude to subjective future — in 67.8% of physicians and 37.41% of nurses. According to MBI data, high EE score was noted in 59.13% of physicians, DP score — in 21.67%, PA score — in 43.03% of doctors. High burnout scores in all three sub-scales were observed in 18.89% of physicians and 8.16% of nurses. Conclusion. Analysis of psychological state and regular psychological testing are essential in COVID-19 departments. This step will be first one towards reducing the negative impact of depression, anxiety, burnout on mental health. © E.V. SINBUKHOVA, D.N. PROTSENKO.