Heart Involvement in Multisystem Inflammatory Syndrome, Associated With COVID-19 in Children: The Retrospective Multicenter Cohort Data.

Objectives: Heart involvement in multisystem inflammatory syndrome associated with COVID-19 in children (MIS-C) is a new challenging problem, requiring fast and reliable diagnostics and appropriate treatment. The aim of this study is to describe heart involvement in patients with MIS-C. Study Design: In this retrospective, multicenter cohort study, data of 122 patients were included. All patients met WHO and CDC criteria of MIS-C. Results: Various types of heart involvement in MIS-C patients were observed. Patients with solely coronary artery lesions (CAL, n = 10, 8.2%) had typical features of Kawasaki disease: younger age, thrombocytosis and normal ferritin level, without giant CA aneurysms, thrombosis, myocardial infarction, shock, and ICU admission. Patients with solely myocardial involvement (MI, n = 30, 24.6%) had an older onset age, elevated ferritin, LDH, the highest D-dimer, H score, and thrombocytopenia level. The following clinical signs were associated with MI: gastrointestinal and central nervous system disorder, sore throat, swelling face, splenomegaly, shock, and treatment in the intensive care unit required. Patients with a combination of CAL and MI (n = 10, 8.2%) had symptoms similar to patients with solely MI, except for impressive thrombocytopenia. Shock and ICU admission were found in 34.7% of patients without heart involvement (n = 72, 59%). One major criterion [troponin > 32 pg/ml (52 points)] or at least two minor criteria [face swelling (32 points) and D-Dimer > 1,300 ng/ml (29 points)] were associated with MI (>32 points) with a sensitivity of 67.5% and a specificity of 88.9%. Conclusion: The above-suggested criteria can be added to routine diagnostic procedures to confirm MI in MIS-C patients.

The Role of Leptin Levels in Adaptation to Cold Climates.

Currently, adipose tissue is considered an endocrine organ that produces hormone-active substances, including leptin, which can play a key role in thermoregulation processes. Therefore, we performed a meta-analysis to investigate the influence of the climatic environment on leptin levels. A systematic literature search in the databases was carried out on 10 January 2020. Finally, 22 eligible articles were included in the current meta-analysis and a total of 13,320 participants were covered in the final analysis. It was shown that males of the "North" subgroup demonstrated significantly higher levels of leptin (10.02 ng/mL; CI: 7.92-12.13) than males of the "South" subgroup (4.9 ng/mL; CI: 3.71-6.25) (p = 0.0001). On the contrary, in the female group, a similar pattern was not detected (p = 0.91). Apparently, in order to maintain body temperature, higher leptin levels are required. The results of the study indicate that such effects are most pronounced in males and to a smaller extent in females, apparently due to a relatively high initial concentration of leptin in females. The correlation between leptin levels and climatic environment data support the hypothesis of leptin-mediated thermoregulation as an adaptive mechanism to cold climates.

Key indicators of obstetric and neonatal care in the Republic of Sakha (Yakutia).

In the absence of a medical birth registry, the official statistics are the only sources of information about pregnancy outcomes in the Republic of Sakha (Yakutia) (RS). We analysed the official statistical data about birth rate, fertility, infant and maternal mortality in the RS in the period 2003-2014. Compared with all-Russian data, the RS had a higher birth rate, especially in rural districts. Maternal and infant mortality were also higher compared with all-Russian data, but had a decreasing trend. The majority of deaths occurred in the small level 1 units. We suggest that establishment of good predelivery transportation of pregnant women with high risk of complications from remote areas and centralization of risk deliveries with improved prenatal and neonatal care could improve the pregnancy outcome in Yakutia.