Cholecalciferol as part of complex therapy for acute COVID-19

During the pandemic of new coronavirus infection, the prevalence of moderate to severe vitamin D deficiency remains high, which is a factor worsening the course of COVID-19. According to some studies, cholecalciferol therapy, added to standard COVID-19 ther-apy, is associated with improving the course and prognosis of the disease. Objective. To evaluate the effect of cholecalciferol therapy at a dose of 100,000 IU on clinical and laboratory parameters in patients with moderate to severe COVID-19 admitted to an infectious hospital. Material and methods. An open single-center interventional study included 129 COVID-19 patients who were further randomized into two groups. Group 1 patients (n=65) received a total dose of 100,000 IU of cholecalciferol in addition to the standard COVID-19 therapy. Group 2 patients (n=64) received standard therapy only. Results. On day 9 of hospitalization, group 1 patients (receiving cholecalciferol) showed a 40.7% increase in serum 25(OH)D level, while group 2 patients (without cholecalciferol therapy) showed a negative trend (p<0.001). In addition, group 1 patients showed higher neutrophil and lymphocyte counts (p=0.047;p=0.025), and a lower level of C-reactive protein (p=0.028). A negative association was found between 25(OH)D levels and CRP values and between 25(OH)D levels and the length of hospital stay. Conclusion. Adding cholecalciferol as a bolus dose to standard COVID-19 therapy has a positive effect on the disease's clinical course and inflammatory markers' levels. Copyright © K.A. GOLOVATYUK, T.L. KARONOVA, A.A. MIKHAILOVA, D.I. LAGUTINA, A.T. CHERNIKOVA, E.YU. VASILIEVA, E.V. SHLYAKHTO.

[SARS-CoV-2 morbidity depending on vitamin D status].

BACKGROUND: The association between vitamin D deficiency and the severity of COVID-19 is currently being actively discussed around the world. AIM: The aim of this study was to assess the prevalence of vitamin D insufficiency and deficiency and compare it with the incidence rates of SARS-CoV-2 in eight Federal Districts of the Russian Federation. MATERIALS AND METHODS: We included 304,564 patients (234,716 women; 77,1%) with serum 25(OH)D levels results performed September 2019 through October 2020. RESULTS: Only 112,877 people (37.1%) had a normal serum 25(OH)D level, others had a deficiency. Vitamin D insufficiency and deficiency was presented with the same frequency in women and men, and no differences were found depending on the geographical location and age in subjects from 18 to 74 years old. However, subjects over 75 years more often had vitamin D deficiency, while subjects under 18 years had normal levels in over 50% cases. In addition, 21,506 patients were tested for SARS-CoV-2 by PCR with further comparison of results with serum 25(OH)D level. The SARS-CoV-2 positivity rate was detected in 3,193 subjects, negative in 18,313. There were no differences in the morbidity in a vitamin D deficiency and a normal level. Thus, 14.8% subjects had positive PCR rates among vitamin D deficiency patients (4,978 tests), 14.9% when 25(OD)D level was from 20 to 30 ng/ml (7,542 tests), 15.0% among those who had 25(OH)D 30- 50 ng/ml (6,622 tests), and 13.9% when vitamin D was more than 50 ng/ml (4,612 tests). CONCLUSION: There was no association between the COVID-19 incidence and vitamin D status in different regions of Russia. Although the nutrient deficiency persists in all regions and is most often diagnosed in people over 75 years old.

Prediction of fatal outcome in patients with confirm COVID-19

SARS-CoV-2, the new coronavirus underlying the development of the COVID-19 pandemic, has led to a sharp increase in the burden on healthcare systems, high mortality and significant difficulties in organizing medical care. The aim of the study was to conduct a systematic analysis of factors affecting the course of infectious disease in patients with diagnosed COVID-19 hospitalized. In order to predict the course of the disease and determine the indications for more aggressive treatment, many different clinical and biological markers have been proposed, however, clinical and laboratory assessment of the condition is not always simple and can clearly predict the development of a severe course. Technologies based on artificial intelligence (AI) have played a significant role in predicting the development of the disease. One of the main requirements during a pandemic is an accurate prediction of the required resources and likely outcomes. In the present study, a machine learning (ML) approach is proposed to predict the fatal outcome in patients with an established diagnosis of COVID-19 based on the patient’s medical history and clinical, laboratory and instrumental data obtained in the first 72 hours of the patient’s stay in the hospital. A machine learning algorithm for predicting the lethal outcome in patients with COVID-19 during 72 hours of hospitalization demonstrated high sensitivity (0.816) and specificity (0.865). Given the serious concerns about limited resources, including ventilators, during the COVID-19 pandemic, accurately predicting patients who are likely to require artificial ventilation can help provide important recommendations regarding patient triage and resource allocation among hospitalized patients. In addition, early detection of such persons may allow for routine ventilation procedures, reducing some of the known risks associated with emergency intubation. Thus, this algorithm can help improve patient care, reduce patient mortality and minimize the burden on doctors during the COVID-19 pandemic. © 2022, ITMO University. All rights reserved.

Rehabilitation after COVID-19. Resolution of the International Expert Council of the Eurasian Association of Therapists and the Russian Society of Cardiology

By the middle of 2021, the official global number of coronavirus disease 2019 (COVID-19) patients was close to 230 million, but the number accounting for asymptomatic patients was much higher. Consequences and rehabilitation after COVID-19 are of particular interest and raise many controversial and unresolved issues. On May 18, 2021, the Eurasian Association of Therapists organized an international panel of experts to analyze challenges associated with the post-COVID-19 period. This panel aimed to develop approaches to identify gaps in the discussed issues. This interdisciplinary team of leading experts reviewed the current literature and presented their data to formulate practical guidance on management of patients after COVID-19. The panel of experts also presented recommendations on how to implement the gained knowledge into health care practices. Copyright © 2021, Silicea-Poligraf. All rights reserved.

COVID-19 Pandemic and Cardiovascular Diseases: Lessons and Prospects.

This article is focused on the topicality of assessing complications and mortality from diseases of the circulatory system during the COVID-19 pandemic. The main variants of damage to the cardiovascular system, the mechanisms of their development, and risk factors are given. The long-term consequences of the new coronavirus infection for the heart and blood vessels are considered. In addition, the necessary measures to reduce the burden of disease after the pandemic are discussed.

Hypertension control during the COVID-19 pandemic: results of the MMM2021 in Russia

Repetitive quarantines and social restrictions during the coronavirus disease 2019 (COVID-19) pandemic have negatively affected the population health in general, and the control of hypertension (HTN) in particular. Aim. To evaluate the control of HTN in the Russian population during the COVID-19 period based on the results of screening for HTN May Measurement Month 2021 (MMM2021). Material and methods. During May-August 2021, 2491 participants from 11 Russian regions took part in the screening. Participation was voluntary without restrictions on sex. All participants were over 18 years of age. During the screening, blood pressure (BP) was measured three times using automatic and mechanical BP monitors. In addition, a questionnaire was filled out on behavioral risk factors, comorbidities and therapy. HTN was diagnosed with systolic BP ≥140 mmHg and/ or diastolic blood pressure ≥90 mmHg and/or taking antihypertensive therapy. The questionnaire included questions about prior COVID-19, vaccinations and their impact on the intake of antihypertensive drugs. Results. The analysis included data from 2461 respondents aged 18 to 92, of which 963 were men (39,1%). The proportion of hypertensive patients was 41,0%, while among them 59,0% took antihypertensives and 30,9% were effectively treated. In comparison with pre-pandemic period according to MMM2018-2019, the higher proportion of HTN patients in the Russian sample was revealed during MMM2021 (41,0% vs 31,3%, p<0,001) with a comparable proportion of patients receiving antihypertensive therapy (60,7% vs 59,0%, p=0,05) and treatment efficacy (28,7% vs 30,9%, p=0,36). Monotherapy was received in 44,7% of cases, while dual and triple combination therapy — in 30,9% and 14,1%, respectively. The majority of respondents (~90%) did not adjust their antihypertensive therapy during the COVID-19 pandemic. Conclusion. According to HTN screening in Russia, there is persistent ineffective control of HTN, which may be due to both the worsening pattern of behavioral risk factors, limited access to healthcare during COVID-19, and the inertia of physicians and low adherence of patients due to the asymptomatic HTN course in the majority.

Coronavirus disease 2019: Features of comprehensive cardiac and pulmonary rehabilitation

The expert consensus of the Russian communities discusses the issues of comprehensive medical rehabilitation of patients with coronavirus disease 2019 (COVID-19). COVID-19 is a contagious infectious disease that can cause pulmonary, cardiac, motor, metabolic, neurocognitive and mental disorders, that is, multiple organ dysfunction. COVID-19 survivors, especially after a severe clinical course, face serious psychological and physical problems, posttraumatic stress, cognitive dysfunction, nutritional deficiencies and exacerbation of concomitant chronic diseases. Some patients, regardless of the COVID-19 severity, have a long clinical course of the disease (“chronic-COVID”, “long COVID”). There is evidence of post-acute COVID-19 syndrome. In this regard, patients after COVID-19 will need rehabilitation measures. The expert consensus of the Russian communities presents general principles, stages and aspects of medical rehabilitation after COVID-19, indications and contraindications for rehabilitation interventions. The paper includes recommendations on comprehensive cardiac and pulmonary rehabilitation, as well as specifics of rehabilitation care for different COVID-19 courses within the national three-stage rehabilitation system.

An open-label multicenter observational study (Registry) of patients recovered from coronavirus disease 2019 (covid-19) with involvement of the cardiovascular system or with baseline severe cardiovascular diseases: Rationale, design, and implications for clinical practice

The potential impact on cardiovascular morbidity and mortality have become one of the most important issues of the coronavirus disease 2019 (COVID-19) pandemic. COVID-19 may be associated with more frequent development of acute cardiovascular complications, while patients with established cardiovascular diseases are characterized by a higher risk of severe infection and adverse in-hospital outcomes. Due to the spread scale of the pandemic, understanding the long-term cardiovascular consequences of COVID-19 is of no less importance. Inability to extrapolate available international data to the Russian population has led to the initiation of a national multicenter study (registry) of patients recovered from COVID-19 and with concomitant involvement of the cardiovascular system or with baseline severe cardiovascular diseases. The article presents its rationale, design and implications of the results for clinical practice.

FEATURES OF ELECTROCARDIOGRAPHIC CHANGES IN NON-CORONAROGENIC SYNDROMES IN PATIENTS WITH COVID-19

The ongoing pandemic caused by virus SARS-CoV-2 encourages the search for ways to save the population. Since people first encountered this disease, it is being actively studied, and updating medical information is extremely valuable. Since people first encountered this disease, it is being actively studied, and updating medical information is extremely valuable. The purpose of this review is to systematize the literature on the effect of SARS-CoV-2 on the cardiovascular system, focusing on changes in the surface electrocardiogram depending on the clinical course of the disease, the characteristics of the treatment and outcomes, and the possible identification of electrocardiographic predictors of complications, as well as sudden cardiac death in patients with non-coronarogenic syndromes with new virus infection (COVID-19). Продолжающаяся пандемия, вызванная вирусом SARS-CoV-2, побуждает искать пути спасения жизней. Поскольку с этим заболеванием люди встретились впервые, оно активно изучается, и крайне ценно обновление медицинской информации. Цель данного обзора - систематизировать литературные сведения о влиянии SARS-CoV-2 на сердечно-сосудистую систему, акцентировав внимание на изменениях поверхностной электрокардиограммы в зависимости от клинического течения заболевания, особенностей проводимого лечения и исходов, и возможным выявлением электрокардиографических предикторов развития осложнений, а также внезапной сердечной смерти у пациентов с некоронарогенными синдромами при новой коронавирусной инфекции (COVID-19).