Spontaneous pneumomediastinum, pneumothorax, pneumoperitoneum and soft tissue emphysema as complication in patients with COVID-19, series of cases.

Spontaneous pneumomediastinum, pneumothorax, pneumoperitoneum, and soft tissue emphysema have been recently described in several sources as possible complications in patients with severe COVID-19 and lung damage. This clinical case is dedicated to demonstrarte the development of these lesions in 3 male patients with comorbid conditions. The putative pathophysiological mechanism of these complications is air leakage due to extensive diffuse alveolar damage followed by rupture of the alveoli. All presented patients had a favorable outcome of the disease without lethal cases, their laboratory data and clinical dynamics were described. It should be noted that such conditions are not rare complications of COVID-19, and are observed mainly in male patients with severe form of the disease and the presence of comorbid conditions. Such complications are associated with long hospitalization and a severe prognosis. In some cases, with a mild course of the disease and positive dynamics in a decrease of the percentage of pulmonary lesions, the outcome is favorable, not requiring additional invasive interventions.Copyright © 2022 Medical Visualization. All rights reserved.

Radiological Features on HRCT Associated with Poor Outcomes among COVID-19 Patients

Background: Ever since the beginning of the COVID-19 pandemic, physicians started investigating the clinical features and lab markers that can assist in predicting the outcome among hospitalized COVID-19 patients. Aim(s): This study aimed to investigate the association between initial chest CT scan findings and adverse outcomes of COVID-19. Material(s) and Method(s): This was a single centre;hospital (inpatient) based prospective cohort study involving 497 COVID-19 patients admitted to the hospital. The adverse outcome included death and mechanical ventilation. We collected data about 14 identifiable parameters available for the HRCT scan. Result(s): Among 14 studied parameters, only 8 features differed significantly among the patients who had favourable and unfavourable outcomes. These features included number of lobes of lungs involved (3 versus 5, p = 0.008), CT Severity score (16 versus 20, p = 0.004), air bronchogram (p=0.003), crazy paving (p=0.029), consolidation (p=0.021), and pleural effusion (p=0.026). We observed that high CT scores coupled with the diffuse distribution of lung lesions were responsible for poor prognosis in most patients. Conclusion(s): Several features of HRCT when combined can accurately predict adverse outcomes among participants and help in triaging the patient for admission in ICU.Copyright © 2023, Dr Yashwant Research Labs Pvt Ltd. All rights reserved.

Efficiency of application of sorbed probiotics in the complex therapy of pneumonia caused by SARS-CoV-2. Quality of life in the short term COVID-19

Aim. To determine the clinical efficacy and safety of the immobilized (sorbed) probiotics Bifidobacterium bifidum 1 (5x108 CFU) and B. bifidum 1 (5x107 CFU) in combination with Lactobacillus plantarum 8P-A3 (5x107 CFU) in the complex therapy of pneumonia caused by SARS-CoV-2 in adult patients without severe risk factors and their impact on health-related quality of life (QoL). Material and methods. An open, randomized prospective study included 100 patients (45 males, 55 females), aged from18 to 60 years without risk factors for severe COVID-19, with pneumonia confirmed by computed tomography and an area of lung lesion no more than 75% (moderate forms). SARS-CoV-2 RNA in nasal and oropharyngeal swabs (RT-PCR) was detected in 72% of the participants, in the rest it was highiy probable in terms of the aggregate parameters. The publication presents the results of self-assessment (94 respondents) of working capacity limitations, shortness of breath, intestinal disorders since the end of the probiotic regimen (PR: hospitalization period - B. bifidum 1, 3 capsules 2 times a day for 10 days, then after hospitalization - B. bifidum 1 in combination with L. plantarum 8P-A3 2 powders 3 times a day for 14 days) and QoL (Short Form Medical Outcomes Study: SF-36) 1 month after hospitalization. Results. At the end of PR, the ability to engage in daily activities was higher by 23.1% [95% confidence interval 5.3-37.3, OR 0.08 (0.08-0.77)]. Difficulty of breathing during exercise was less common by 29.7% [15.1-44.5%], OR 0.09 [0.02-0.40], hard stools and no bowel movements were recorded less often by 21.3% [8.5-34, 1] for 1-3 days. One month after hospitalization, the QoL of the patients receiving standard treatment was significantly reduced relative to population indicators in Russia. It was more significantly due to the psychological component of health [total measurement 38.1 (36.2-40.0)] and less significantly due to the physical component [49.5 (48.3-50.8)]. The main reasons limiting daily activities [Role Emotional (RE): 39.4 (37.4-41.4)] were decreased vitality [VT: 40.2 (38.9-041.5)], emotional depression [Mental Health (MH): 41.2 (39.4-43.0)], deficit of social contacts [Social Functioning (SF): 45.1 (43.7-46.6)]. The patients who received PR had a higher ability to carry out daily activities [RE: 57.7 (55.6-59.7)], the severity of psychological problems associated with fatigue, anxiety and depression was lower [MH: 59.8 (58.7-60.9), p<0,001]. The effect of the PR on negative perceptions of social isolation was comparatively less [SF: 53.9 (52.2-55.4)]. The QoL of the patients who additionally suffered from diarrhea in the acute period of SARS-CoV-2 pneumonia was worse in comparison with the patients without diarrhea (due to pain and inability to endure physical activity). The effects of immobilized (sorbed) probiotics to the QoL of the patients with diarrhea during the acute period of COVID-19 were most significant. Conclusion. PR had a significant positive effect on the QoL within a month after hospitalization, increasing working capacity and improving mental health, reducing the severity of psychological problems and fatigue. Additional researches are needed on the possible relationship of organic and functional gastrointestinal diseases with the progression of diarrhea in patients infected with SARS-CoV-2. No side effects of the sorbed probiotics regimen have been identified.Copyright © Eco-Vector, 2022.

Myocardial injury in coronavirus infection combined with lung, skin and kidney lesions: Clinical case and literature review

The most common clinical manifestation of new coronavirus infection is bilateral pneumonia. At the same time, COVID-19 has a wide range of cardiovascular complications, with the development of acute heart failure, arrhythmias, acute coronary syndrome, and myocarditis. Myocardial injury is relatively common in COVID-19, accounting 7-23 % of cases. The presented clinical case describes a 56-year-old patient with a confirmed coronavirus infection. The peculiarity of this clinical case is that it is the first report on COVID-19 with systemic manifestations: lungs, heart, kidneys and skin lesions. It should be noted that despite viral pneumonia typical for COVID-19, clinical picture and severity of the patient's condition were determined by the developed myocardial injury. The presented clinical case is specific due to skin lesions.Copyright © 2021, Krasnoyarsk State Medical University. All rights reserved.

Evaluating the Effectiveness of Intravenous Ozonated Normal Saline in the Treatment of Severe COVID-19 Disease: A randomized control trial

Background: There is still no specific treatment strategy for COVID-19 other than supportive management. The potential biological benefits of ozone therapy include reduced tissue hypoxia, decreased hypercoagulability, modulated immune function by inhibiting inflammatory mediators, improved phagocytic function, and impaired viral replication. This study aimed to evaluate the effect of intravenous ozonated normal saline on patients with severe COVID-19 disease. Method(s): In this study, a single centralized randomized clinical trial was conducted on 80 hospitalized patients with severe COVID-19. The patients were selected by random allocation method and divided into two groups A and B. In group A (control group), patients were given standard drug treatment, and in group B (intervention group), patients received ozonated normal saline in addition to the standard drug treatment. In the intervention group, 400 mL of normal saline was weighed by 40 mug/ kg of body weight and was injected into patients within 15 to 30 minutes (80 to 120 drops per minute). This process was done daily every morning for a week. Primary and secondary outcomes of the disease included changes in the following items: length of hospital stay, inflammatory markers including C-reactive protein (CRP), clinical recovery, arterial blood oxygen status, improvement of blood disorders such as leukopenia and leukocytosis, duration of ventilator attachment, and rapid clearance of lung lesions on CT scans. The need for intensive care unit (ICU) hospitalization, the length of ICU stay, and the mortality rate in patients of the two groups was compared. Result(s): According to the results of the initial outcome variable analysis, the probability of discharge of patients who received the normal ozonated saline intervention was 33% higher than patients who did not receive this intervention;however, this relationship was not statistically significant (HR = 0.67, 95%, CI = 0.42-1.06, P value = 0.089). The chance of ICU hospitalization in patients of the intervention group was three times more than that of the comparison group, but this relationship was not significant (odds ratio = 4.4 95% CI = 1.32-14.50, P value = 0.016). The use of ozonated normal saline was found to increase the risk of death by 1.5 times but this relationship was not statistically significant (odds ratio = 1.5, 95% CI = .24-9.75, P value = 0.646). Ozonated normal saline had a significant effect on changes in respiration rate (in the intervention group the number of breaths was decreased) and the erythrocyte sedimentation rate (in the intervention group the erythrocyte sedimentation rate was increased);however, it had no significant effect on other indicators. Conclusion(s): The present study showed that ozone therapy in hospitalized patients with severe COVID-19 could help improve some primary and secondary outcomes of the disease. Governments and health policymakers should make ozone therapy an available care service so that the need for advanced treatment facilities decreases;consequently, this measure may improve patient safety, prevent lung tissue destruction, and control cytokine storms in patients. Additionally, health decision-makers need to aim for the effective clinical improvement of patients, especially severe ones, and the reduction of their mortality. However, further large-scale multicenter studies with larger sample sizes considering drug side effects and other variables influencing the clinical course of COVID-19 can provide more information on the effectiveness and importance of ozone therapy.Copyright © 2023 The Author(s);Published by Kerman University of Medical Sciences.

CLINICAL CASE OF SEVERE COVID-19 IN A CHILD WITH MORBID OBESITY.

The pandemic of coronavirus infection is characterized by a low percentage of complications and severe forms in sick children compared to the adult population. However, there have been described cases of severe clinical course of COVID-19 in children with comorbidities among which is obesity. The aim of this study was to analyze the severe course of a new coronavirus infection paralleled with morbid obesity in a pediatric patient. Materials and methods. All accompanying patient medical documentation was examined. Results and discussion. From the anamnesis of life it is known that the patient was long time complained of intensively increased body weight, on which she repeatedly underwent examinations. In 2018, hypothalamic pubertal syndrome was diagnosed for the first time, for which the patient received hypoglycemic and antihypertensive drugs, hepatoprotectors on an ongoing basis. In the epidemiological anamnesis, the intrafamilial COVID-19 contact with mother was established. The main disease began acutely with a rise in body temperature up to 39-39.5degreeC, cough and weakness. During the first week of illness, the patient did not seek medical help and receive self-treatment, but the positive effect was not achieved. Saturation measurement showed low oxygen level (SpO2 71%). In this regard, the patient underwent chest computed tomography, which revealed a bilateral interstitial polysegmental lung lesion with signs of consolidation. After emergency hospitalization, the patient was prescribed empiric antibiotic therapy, anti-inflammatory and antithrombotic treatment, as well as respiratory support. A positive PCR result of a throat and nasal swab for SARS-CoV-2 was obtained in the hospital. Due to a poor response to therapy, the patient was transferred to a respiratory hospital. At the time of hospitalization, the condition was considered severe due to severe respiratory failure and premorbidity. The range of treatments included oxygenotherapy, antibacterial and anticoagulation therapy, as well as surfactant and the nucleoside analogue Remdesivir. During treatment, the clinical picture gained a positive trend, and after 6 days of hospitalization the patient no longer needed respiratory support. According to the results of repeated computed tomography, bilateral interstitial polysegmental pneumonia was diagnosed with damage to the lung tissue up to 95%. The patient remained stable and showed no signs of respiratory failure during the following days of hospitalization. On the 20th day of ilness, the patient was discharged from hospital with full clinical recovery. Conclusion. This clinical case demonstrates the role of premorbid background in aggravating the clinical picture of a new coronavirus infection in a child. Careful study of anamnestic characteristics is necessary in patients of any age, even with an uncomplicated disease course.Copyright © 2023 Saint Petersburg Pasteur Institute. All rights reserved.

Lung cavitation as a rare complication of severe COVID-19: report of 3 cases

Introduction: Lung cavitation is a rare radiological finding of COVID- 19 pneumonia associated with unfavorable outcome. Its pathogenesis is unclear and it is characterized by diffuse alveolar damage, intra-alveolar hemorrhage and necrosis of parenchymal cells. Method(s): We retrospectively reviewed the radiological findings of COVID-19 patients admitted to our ICU during the pandemic in order to identify the development of lung cavitary lesions. Result(s): From 11/2020 until 10/2022 1000 patients were admitted to our COVID-19 ICU (92% on invasive mechanical ventilation). According to our data there were three cases of lung cavity formation. The first case was a 78 years male with history of hypertension. Chest CT (Day26) showed a 11.6 cm cavity in the right middle lobe (Fig. 1). The second case was a 52 year old female with history of diabetes mellitus, obesity, hypertension and rheumatoid arthritis. Follow up chest CT (D29) revealed progressive development of multiple bilateral cavitary lesions. The third case was a 61 year old male with no medical history, who developed (D17) multiple cavitary lesions in both lower lobes, concomitant with left-sided pulmonary embolism. The presence of other well defined etiologies of cavitary lesions such as mycobacterial and fungal infections as well as neoplasmatic or autoimmune diseases had been widely excluded. However, since pulmonary cavitation is a late complication of severe COVID disease, we cannot overlook the fact that all patients suffered from superinfections by XDR Acinetobacter baumanii and/or Klebsiella pneumonia, as most of our patients with prolonged length of stay. Moreover, two of the three patients developed pneumothorax. All patients finally died. Conclusion(s): Although bacterial co-infection does not allow absolute association between cavitary formation and coronavirus disease, it seems that destructive triggers, such as bacteria or mechanical ventilation, may aggravate COVID underlying lung lesions leading to cavitation.

Histomorphological Spectrum of Lung Lesions at Autopsy-A Tertiary Care Centre Experience

Background and aims: A wide variety of pathological conditions involve the lungs. In autopsy, the lungs are examined for disease, injury and other findings suggesting cause of death or related changes.Aims & Objectives: The present study aimed to study the histomorphological spectrum of lung lesions at autopsy and to assess the frequency of different types of lesions;and to associate histomorphological changes with cause of death.Material and Methods: It was a one-year observational study conducted in the Department of Pathology, Govt. Medical College, Jammu. Lung tissue pieces from all medicolegal autopsies received were fixed, examined grossly, processed;paraffin embedded sections obtained were stained with Hematoxylin and Eosin stain and examined under microscope. Findings were recorded and tabulated. Result(s): Out of 264 cases, males were predominantly affected (84%);median age was 38 years. The various changes observed were congestion (68%), edema (45.4%), pneumonia (5%), granulomatous inflammation (3%), diffuse alveolar damage (1.5%), haemorrhage (14.4%), interstitial changes (60%), malaria (0.4%) and malignancy (0.4%). Natural deaths were the commonest cause (75, 28%) followed by asphyxial deaths (65, 24.6%). Conclusion(s): Histopathological examination of lung autopsies highlights many incidental findings, establishes underlying cause of death, serves as a learning tool and also holds scope for detection of newer diseases.Copyright © 2023 JK Science.

Lung Lesion Images Classification Based on Deep Learning Model and Adaboost Techniques

Today, the medical industry is promoting the research and application of artificial intelligence in disease diagnosis and treatment. The development of diagnostic methods with the support of electronic devices and information technology can help doctors save time in diagnosing and treating diseases, especially medical images. Diagnosis of lung lesions based on lung images is a case study. This paper proposed a method for lung lesion images classification based on modified U-Net and VGG-19 combined on adaboost techniques. The modified U-Net architecture with 5 pooling and 5 unpooling. It has the unpooling layer with kernels of size 2 × 2, stride 2 × 2 to get output consistent with the adaboost. The result of the proposed method is about 97.61% and better results than others in the Covid-19 radiography dataset. © 2023, ICST Institute for Computer Sciences, Social Informatics and Telecommunications Engineering.

EXTRACORPOREAL THERAPY IN CRITICALLY ILL PATIENTS WITH COVID-19: A SINGLE-CENTER EXPERIENCE.

Aim To assess the safety and efficacy of extracorporeal therapy in patients with COVID-19. The study included 27 patients aged 67+/-9.7 [min 38, max 87] years with a laboratory-confirmed SARS-CoV-2 and bilateral polysegmental pneumonia, various concomitant chronic diseases who were admitted to Intensive Care Unit and received extracorporeal therapies. All patients had the mean NEWS score of 6.9+/-2.7 [min 4, max 9] and the mean SOFA score of 8.1+/-3.1 [min 3, max 16] at admission Methods to the ICU. 19 patients (70.4%) had severe lung lesions over 75% according to the chest CT scans. 48 extracorporeal therapies were performed using the Multifiltrate (Fresenius Medical Care, Germany) and Aquarius (Nikkiso Aquarius RCA, Great Britain) medical devices. Indications for extracorporeal therapy initiation included cytokine storm associated with acute respiratory distress syndrome and septic shock. Generally, each patient received at least one extracorporeal therapy. 11 patients underwent 2 to 6 sessions. Isolated plasma separation and hemoperfusion helped to reduce vasopressor / cardiotonic support, slightly improved ventilation parameters, with a significant, but not long-term decrease in the levels of inflammation markers. Combining different modalities of extracorporeal therapy that provide rapid elimination of agents, controlled temperature response and hydration, maintaining Results homeostasis and detoxification, appeared to be most optimal. Extracorporeal therapy did not improve the volume of lung parenchyma or lung parenchyma damage. However, 19 (70.4%) patients who received extracorporeal therapy transitioned from mechanical ventilation to spontaneous breathing, whereas 8 (29.6%) patients had severe lung lesions (over 75%) according to the repeated chest CT scans. The mean length of stay in the ICU among survivors was 9+/-3.5 [min 4, max 22]. The 28-day mortality and in-hospital mortality rate was 25.9% (7). Prolonged extracorporeal therapy in patients with SARS-Cov-2 has demonstrated Conclusion efficacy in relieving organ dysfunctions and shock states, but did not significantly affect the remaining lung parenchyma damage.Copyright © 2022 University of Latvia. All Rights Reserved.

Clinical and paraclinical manifestation COVID-19 in different age children

Purpose - to establish the clinical and paraclinical manifestations of the course of COVID-19 in children, depending on age to predict the severity of the disease's manifestation. Materials and methods. The 60 children aged from 3 months to 17 years old with laboratory-confirmed SARS-CoV-2 were examined. All patients underwent general clinical, laboratory, and instrumental examinations and received therapy according to Ukrainian National protocol. SARS-CoV-2 infection was confirmed by real-time PCR. Results. Thus, in young children COVID-19 begins acutely (90.0%) with intoxication (75.0%), fever (65.0%), nasal congestion (25.0%), rhinorrhea (20.0%), dry cough (60.0%), increased ESR and C-reactive protein (55.0%). The course of COVID-19 in children 4-6 years is accompanied by acute onset (85.71%), fever (85.71%), pharyngitis (85.71%), lymphopenia (28.56%), and no CT signs of lesions (71.43%). In children 7-12 years old, COVID-19 causes intoxication (88.89%), fever (83.33%), pharyngitis (55.56%), dry cough (77.78%), lymphocytosis (16.67%) with accelerated ESR (38.89%) and pneumonia (38.89%). The course of COVID-19 in children was older than 13 years old characterized by fever (73.33%), pharyngitis (66.67%), dry cough (73.33%), olfactory loss (20.0%), leukopenia (20.0%), ESR acceleration (20.0%), and a decrease in prothrombin (13.33%) without pulmonary lesions (73.33%). Conclusions. These data suggest that the severity and duration of clinical and laboratory manifestations of COVID-19 depend on the child's age. The course of COVID-19 in children of all age groups is mostly of moderate severity with a favorable prognosis ((56.67%) hospitalized children did not have any complications). Only children from 7 to 12 years old need additional attention due to the severe manifestations of intoxication (88.89%) and the risk of complications with pneumonia (38.89%). The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.Copyright © 2022 Modern Pediatrics. Ukraine. All rights reserved.

Physician-led ultrasound interventions: Rapid diagnosis of lung cancer during the COVID-19 pandemic

Introduction: Lung cancer management depends upon a timely histological diagnosis. Unprecedented pressure on various diagnostic facilities were observed during the COVID-19 pandemic. In our hospital, physician-led thoracic ultrasound guided biopsies and Rapid-On-Site-Evaluation (ROSE) ensured the prompt enrollment in the lung cancer diagnostic pathway. Aim and objectives: The COVID-19 pandemic has affected the lung cancer pathway adversely due to aerosol generating procedures, infection control, limited bronchoscopy, endobronchial ultrasound and computed tomography (CT) sessions. During this challenging time, we aimed to maintain a swift and consistent lung cancer pathway, aided by physician-led ultrasound guided interventions. Method(s): A twelve-month prospective analysis was performed on a cohort of all patients with a histological diagnosis of lung cancer, examining methods used for tissue sampling. Result(s): Between April 2020 to March 2021, our lung multi-disciplinary meeting decided the clinical management of 91 patients with confirmed histology. 41% (37/91) of those had biopsies via physician-led ultrasound-interventions. Sites sampled yielding tissue diagnosis were;59% (22/37) supraclavicular fossa nodes, 30% (11/37) lung lesions, 5% (2/37) pleural lesions, 3% (1/37) bone and 3% (1/37) axillary lymph node. Conclusion(s): Our study shows that physician led ultrasound guided biopsies and ROSE are safe and robust for prompt and speedy lung cancer management. It has future research potentials. We welcome comments and experience of other teams in this regard.

The burden of a new coronavirus infection in a Children's multidisciplinary hospital in St. Petersburg 2020-2021.

Objective: To describe the burden of COVID-19 in a children's multidisciplinary hospital for two years of the pandemic, taking into account of age, severity of the disease, the spectrum of underlying conditions and the intensive care need. Method(s): An assessment of 6048 cases of COVID-19 in patients under 18 years of age hospitalized from March 26, 2020 to December 31, 2021 was carried out. The diagnosis was confirmed by PCR on an outpatient basis or after hospitalization with the help of diagnostic kits registered in the Russian Federation. The features of the work of a children's multidisciplinary hospital in new conditions, the dynamics of hospitalization, age characteristics and new coronavirus (CV) infection severity in the pandemic development process are presented. The analysis of the underlying condition's structure depending on the severity of the disease, as well as the need and volume of therapy in the intensive care unit. The frequency and main characteristics of children's multisystem inflammatory syndrome (MIS-C) in hospital conditions, long-term PCR positivity and its effect on the duration of inpatient treatment of children have been established. Result(s): The spread of SARS-COV-2 in St. Petersburg required a radical change in the work of the children's multidisciplinary hospital. During the two years of the pandemic, four waves of hospitalization of children with new CV were revealed, differing in duration, intensity, and frequency of lung damage, but having no significant differences in the proportion of severe forms of the disease (1.7-2.8% of cases). Intensive therapy was required in 3.6% of cases, of which only 1/3 was due to the severe course of COVID-19 with a lung lesion volume of up to 100%. In 1/3 of cases, patients had risks of developing severe forms and in 1/3 - other pathology. Severe course of new CV was significantly more often accompanied by the need for respiratory support, anticoagulants and anti-inflammatory therapy. Contributing factors of severe forms and unfavorable outcomes were: pathology of the central nervous system, genetic diseases and malformations, obesity, as well as chronic bronchopulmonary pathology. Mortality in the hospital was recorded only among children with severe underlying conditions (0.1% of cases). D-MVS was registered significantly more often in boys (7 out of every 10 patients), accounting for 1.2% of cases of hospitalization of children with new CV over the entire period. Convalescent PCR-positivity in the outcome of COVID-19 was detected in 1/3 of children, significantly more often during the autumn-winter waves of the pandemic and among patients of high school age. Conclusion(s): New CV is gradually strengthening its position in the structure of acute respiratory pathology in children. Some of SARS-COV-2 infection cases is accompanied by extensive lung damage, as well as severe systemic inflammation independently or in the other infectious diseases structure, induction of the debut of various somatic pathology is not excluded. The presented data confirm the need for increased attention at high risk of adverse respiratory diseases outcomes children. All severe cases of COVID-19 in children require a personalized approach, taking into account the existing background diseases and possible options for the progression of the process. MIS-C should be considered as a systemic inflammatory response syndrome within the framework of an infectious disease of various etiologies, differentiated with Kawasaki disease and the debut of systemic diseases. The long-term PCR-positivity in the outcome of COVID-19 requires further study to address the need and nature of therapy in order to prevent further spread of infection in the population.Copyright © 2022 Interregional public organization Association of infectious disease specialists of Saint-Petersburg and Leningrad region (IPO AIDSSPbR). All rights reserved.

The burden of a new coronavirus infection in a Children's multidisciplinary hospital in St. Petersburg 2020-2021.

Objective: To describe the burden of COVID-19 in a children's multidisciplinary hospital for two years of the pandemic, taking into account of age, severity of the disease, the spectrum of underlying conditions and the intensive care need. Method(s): An assessment of 6048 cases of COVID-19 in patients under 18 years of age hospitalized from March 26, 2020 to December 31, 2021 was carried out. The diagnosis was confirmed by PCR on an outpatient basis or after hospitalization with the help of diagnostic kits registered in the Russian Federation. The features of the work of a children's multidisciplinary hospital in new conditions, the dynamics of hospitalization, age characteristics and new coronavirus (CV) infection severity in the pandemic development process are presented. The analysis of the underlying condition's structure depending on the severity of the disease, as well as the need and volume of therapy in the intensive care unit. The frequency and main characteristics of children's multisystem inflammatory syndrome (MIS-C) in hospital conditions, long-term PCR positivity and its effect on the duration of inpatient treatment of children have been established. Result(s): The spread of SARS-COV-2 in St. Petersburg required a radical change in the work of the children's multidisciplinary hospital. During the two years of the pandemic, four waves of hospitalization of children with new CV were revealed, differing in duration, intensity, and frequency of lung damage, but having no significant differences in the proportion of severe forms of the disease (1.7-2.8% of cases). Intensive therapy was required in 3.6% of cases, of which only 1/3 was due to the severe course of COVID-19 with a lung lesion volume of up to 100%. In 1/3 of cases, patients had risks of developing severe forms and in 1/3 - other pathology. Severe course of new CV was significantly more often accompanied by the need for respiratory support, anticoagulants and anti-inflammatory therapy. Contributing factors of severe forms and unfavorable outcomes were: pathology of the central nervous system, genetic diseases and malformations, obesity, as well as chronic bronchopulmonary pathology. Mortality in the hospital was recorded only among children with severe underlying conditions (0.1% of cases). D-MVS was registered significantly more often in boys (7 out of every 10 patients), accounting for 1.2% of cases of hospitalization of children with new CV over the entire period. Convalescent PCR-positivity in the outcome of COVID-19 was detected in 1/3 of children, significantly more often during the autumn-winter waves of the pandemic and among patients of high school age. Conclusion(s): New CV is gradually strengthening its position in the structure of acute respiratory pathology in children. Some of SARS-COV-2 infection cases is accompanied by extensive lung damage, as well as severe systemic inflammation independently or in the other infectious diseases structure, induction of the debut of various somatic pathology is not excluded. The presented data confirm the need for increased attention at high risk of adverse respiratory diseases outcomes children. All severe cases of COVID-19 in children require a personalized approach, taking into account the existing background diseases and possible options for the progression of the process. MIS-C should be considered as a systemic inflammatory response syndrome within the framework of an infectious disease of various etiologies, differentiated with Kawasaki disease and the debut of systemic diseases. The long-term PCR-positivity in the outcome of COVID-19 requires further study to address the need and nature of therapy in order to prevent further spread of infection in the population.Copyright © 2022 Interregional public organization Association of infectious disease specialists of Saint-Petersburg and Leningrad region (IPO AIDSSPbR). All rights reserved.

Segmental lung anatomy for ultrasound assessment for post-COVID conditions

Introduction: Ultrasound (US) has become a more reliable method for lung parenchyma assessment. Precise detecting localization and effective monitoring treatment is crucial in respiratory medicine patients. The aim was to evaluate the accuracy of the US to detect and monitor lung lesions in compliance with lung segmental anatomy in post-COVID patients with associated comorbid respiratory conditions. Materials: We did an evaluation of 30 consecutive patients (25-74?years), who suffered from various chronic respiratory conditions and underwent COVID-19 during the last 3 months. All patients underwent first line lung ultrasound followed by CT and bronchoscopy where needed. Result(s): US can detect correctly in 28/30 cases to verify lesion and segmental localization as confirmed on CT and/or endoscopy. The US was effective to monitor treatment in 24/30 cases without need for follow up CT, including 5 patients after bronchoscopic lavage. Various specific conditions were detected and monitored on US: segmental atelectasis, pneumonia (22 cases);right middle lobe atelectasis (3);bronchiectatic disease (3);lung cirrhosis, post tuberculosis changes (2). Lung compression / atelectasis due to severe scoliosis and thoracic deformities detected in 2 patients. In some cases US was more effective vs CT due to possibility of real time ventilation observation, detecting tissue movement;dorsal areas ventilation was underdetected on CT due to patients'position. Conclusion(s): US can be used for detecting peripheral lung lesions, precise determination of segmental localization, is important for early diagnosis and monitoring.

Chest CT scan features in COVID-19 pneumonia according to duration of symptoms

Introduction: High-resolution chest CT is considered as an early screening and diagnostic tool in COVID-19 pneumonitis. A wide variety of CT findings in COVID-19 have been reported, which differ according to the stage of the disease and its severity. Aim(s): Assessment of CT scan features among patients with COVID-19 pneumonia according to duration of symptoms. Method(s): Retrospective study including patients infected with COVID-19;confirmed either by RT-PCR or Rapid Antigen Test and hospitalized in COVID-19 unit from September 2020 to June 2021. In total,among 626 patients,567 CT data were available and classified according to the time of CT scan after symptoms onset: Stage 1 (0-7 days);Stage 2 (8-15 days);Stage-3 (>15 days). In each CT report, the following information was specified: extent of the lesions, presence of ground glass lesions, condensations, pleural effusion and pericardial effusion, as well as the distribution of the lesions. Result(s): We included 567 patients: Stage1: 276 patients (48%), Stage2:248 patients (44%) and Stage 3:43 patients (8%). Mean age was 62,6 years [23-94] and sex ratio was 1,3. Mean extent of lesions has increased from stage 1 to stage 3 (43%, 48%, 56%;p=0.000). The frequency of ground glass lesions was significantly higher in stage 2 (91%,95%, 86%)(p=0.038). Consolidations were mainly present in G2 and G3 (64%, 68%, 70%;p=0.02). The presence of pleural and pericardial effusion was not significantly different between stages (7,2%;6,8%;9,3%;p=0.745) and (8,6%;10,3%;19,4%;p=0.128) respectively. Conclusion(s): Chest CT can highlight abnormalities even during early phases of infection and provide an analysis of the extent and severity of lung lesions according to different stages.

Surfactant protein-A (SP-A)is a novel marker of lung disorders in patients discharged after COVID-19 pneumonia

The aim: was to estimate role of SP-A in patients (pts) discharged after COVID-19 pneumonia. Material(s) and Method(s): main group was 75 pts (36 (48,0%) men, age - 54,2 (49,3;57,1)) on 46,5 (42,4;53,1) days after the onset of COVID-19. Pts were divided into 3 subgroups: 1 - 27 pts after moderate COVID-19 pneumonia, 2 - 30 pts after severe COVID-19 pneumonia, 3 - 18 pts after critical COVID-19 pneumonia. All pts before COVID-19 had no history of previous lung disease. Control group - 15 healthy persons. Measurements: dyspnea by mMRC, SpO2, SP-A in serum. Result(s): After 1,5 months the onset of COVID-19 74 pts (98,7%) had dyspnea, but level of SpO2 Me 97,5 (96,3;98,8)% was normal. Level of SP-A didn't differ between subgr. 1 and control gr. (p>0,05). But level of SP-A was significantly higher in pts of subgr. 2 and subgr. 3 in comparison with control gr. and subgr. 1 (p<0,01) (Fig.1). At the same time, it was strong direct correlation between the level of SP-A and severity of dyspnea by mMRC (Fig.2). Conclusion(s): 1) the level of SP-A is an independent predictor of lung lesion in early post-COVID-19 period in pts after severe and critical COVID-19 pneumonia;2) damage of the surfactant system of the lungs can be the reason of dyspnea in the early period after COVID-19;2) determination of SP-A is important element to customize the most appropriate therapeutic strategies for pts after severe and critical COVID-19.

Clinico-etiological Profile of COVID-19 Cases with Cavitary Lung Lesions

Background: Pulmonary cavitation as a radiological finding in COVID-19 has been documented in case reports and small case series with a variety of etiologies deemed responsible. However, there is no large data addressing the issue. Hence, we present the data of forty-two COVID-19 patients at our institute, who were diagnosed and evaluated for cavitary lung lesions. Methodology: Records of consecutive COVID-19 patients, diagnosed and evaluated for cavitary lung lesions over a period of three months from April to June 2021, were reviewed retrospectively. Result(s): 42 patients were diagnosed with cavitary lung lesions during study duration, 19 (45%) during the course of admission and 23 (55%) on readmission. Majority of patients (n=36, 86%) were detected with cavitary lung lesion between 4th to 7th week from symptom onset, while only 6 patients (14%) were detected in 2nd and 3rd week. Mean duration between symptom onset and evidence of cavity on chest tomography was 18 and 32 days in the course and readmission group, respectively. Mucor species, Aspergillus fumigatus and Candida albicans among fungal organisms and Acinetobacter baumannii and Klebsiella pneumoniae among bacterial organisms were predominantly associated with cavitary lesions. Conclusion(s): Cavitary lung lesions associated with COVID-19 are not uncommon and can be detected during the absorptive phase of disease itself or much later during readmission. We found that bacterial and fungal infections are commonly associated. Hence, prompt diagnosis and management should be initiated keeping these etiologies in mind to prevent further morbidity and mortality due to COVID-19.

HD-tDCS in acute and long-term COVID-19

Symposium title: The potential role of tDCS in the management of Post-Acute Sequelae of SARS-COV-2 (PASC) Symposium description: The novel SARS-CoV-2 virus has infected millions of people worldwide. Post-infectious symptoms, referred to as Post-Acute Sequelae of SARS-CoV-2 (PASC), affect a large and growing segment of survivors, lasting months or even years without recovery. With continuous COVID-19 infections, PASC is a growing problem for public health. Therefore, effective and accessible treatment options need to be evaluated urgently. PASC symptoms are multi-systemic and can vary by the individual in clinical presentation, and its underlying pathological mechanisms remain uncharacterized. tDCS is a well-tolerated and extensively characterized noninvasive neuromodulation technique, and is effective in targeting the neuropsychiatric symptoms that define PASC (i.e., fatigue, cognitive, pain, emotional) including in other post-viral conditions. In addition, tDCS may have a larger role in the management of persisting respiratory symptoms. We will provide an overview of the theoretical basis and work to date supporting tDCS as a tool for PASC management, and present initial findings from recently completed and ongoing clinical trials. When COVID-19 first emerged, many researchers were focused on its impact on the lungs. As we have learned more about SARS-CoV-2 and resulting COVID-19, we have discovered that patients present a greater complexity in the context of the neurotrauma and the pulmonary lesions can become an aggravation of the neuroinvasion of the coronavirus and originate from cerebral injury. Recently, it has been suggested that noninvasive brain stimulation could be a valuable tool for the management of the early and postacute phase of patients with COVID-19. This session will present the results of our investigation of the High-definition transcranial direct current stimulation effects during the acute and chronic recovery phase from COVID-19. The prognostic factors and clinical predictors that contribute to greater response to treatment will be presented and directions for future research will be discussed. Research Category and Technology and Methods Clinical Research: 9. Transcranial Direct Current Stimulation (tDCS) Keywords: HD-tDCS, Coronavirus disease, Noninvasive brain stimulation, Long COVID-19Copyright © 2023

Imagistic lung findings using ArtificialIntelligence in SARS CoV2 hospitalized patients based on vaccinal status

The lung is one of the most affected organs by the novel virus and the imagistic exploration of the thorax such as CT scanning and X-Ray has had an important impact in assessing the severity of the disease. The study aims to investigate the presence of pulmonary lesions using Artificial Intelligence (AI) in SARS CoV2 hospitalised positive patients, based on vaccinal status from September 2021 - to January 2022. We conducted a cohort study in which we included 186 patients from which only 124 patients had their CT scans analyzed with the algorithm. In this study, we investigated the extension of lung lesions in SARS CoV2 positive patients based on their vaccinal status using an artificial intelligence algorithm. The majority of the study population was composed of males (57%), unvaccinated patients (84%) with comorbidities (79.03%). More than double unvaccinated patients compared to unvaccinated ones have been found to have more than 75% of the lungs affected. Patients in the age group 30-39 have had the most lung lesions with a mean of 69% of both lungs affected. Unvaccinated patients with comorbidities have had 5% more lung lesions than vaccinated patients with comorbidities. The interpretation time of a CT scan has been reduced by 50% using AI and in 85% of cases, the mathematical algorithm has had similar results to the ones provided by the radiologist. The study revealed a higher percentage of lung lesions among unvaccinated SARS CoV2 positive patients admitted to the hospital, underlining the importance of vaccination and also the importance of artificial intelligence in the management of a SARS CoV2 patient.