Efficiency of Levilimab in patients with moderate and severe COVID-19

BackgroundBiologic treatments are inherently associated with an increased risk of infections, and recipients are intuitively considered at-risk for a more severe course of COVID-19. However, the actual risks are not fully described, neither are the appropriate adjustments needed to mitigate such risks. MethodsNation-wide registry was set up by Israeli IBD Section, to characterize course of COVID-19 in IBD patients who contacted SARS-CoV-2 infection while on biologics. We prospectively collected demographic and clinical data, and analyzed COVID-19 outcomes with regard to the specific treatments.ResultsBetween Apr and Oct 2020, 144 patients with an established IBD diagnosis and confirmed COVID-19 were enrolled at 20 IBD referral centers. The majority of patients was under the age of 40 (113, 78%), 9 (6%) were younger than 18, only 4 patients (3%) over the age of 70.94 patients received biologics, as monotherapy (76, 52.8%), combined with immunomodulators (9, 10%) or concomitant corticosteroids (9, 10%).37 patients (26%) were reported with moderate and severe COVID-19 course, third of them (13) on biologics. 24 patents (17%) were admitted for hospitalization, the rest managed in home setting (114, 79%) and hotels converted into makeshift healthcare facilities (6, 4%). Fifteen patients (10%) required non-invasive ventilation and oxygen support, 3 patients (2%) went on mechanical ventilation. All patients recovered uneventfully, with no mortalities reported.Age was the most significant factor associated with moderate and severe disease. We found no correlation between bowel disease activity and the severity of COVID-19 course.The rate of serious COVID-19 for the 94 patients who had received biologics was significantly lower than that of 50 patients who were not treated with biologics (13/94 vs 24/50; RR 0.29 [95% CI, 0.161–0.515]; p < 0.0001). On adjusting for age, gender, comorbidities, IBD phenotype and activity, the surprising ameliorating effect associated with biologics was profound and significant (OR, 0.082 [95% CI 0.009-0.621], p =0.013) in all age categories. ConclusionOur results are reassuring and encouraging, and do not suggest that therapeutic immune suppression renders IBD patients particularly vulnerable for more severe course of the COVID-19. Adjusted odds for severe COVID-19 course actually decreased significantly in patients treated with biologics. It could be speculated that cytokine inhibition may mitigate progression of the infection to a devastating hyperinflammatory state. Continuing necessary maintenance immune suppression seems to be appropriate and safe approach, despite the COVID-19 pandemic.

The long-term course of protection against severe COVID-19 courses by vaccine-induced or hybrid immunity in Germany is unclear. We studied 146 457 cases aged 60-99 years in the German federal state of Bavaria who were immunized against COVID-19 and tested positive for it from February 2022 to January 2023. We calculated adjusted hazard ratios for a severe course (hospitalization or death due to COVID-19) for different intervals between the onset of full primary or booster immunity and the date of the infection. 3342 (2.3%) severe courses of COVID-19 were observed in the first 60 days after the infection. The risk of a severe course rose with the interval between the onset of immune protection and the infection (adjusted hazard ratios and 95% confidence intervals at 6, 9, 12, and 15 months: 1.14 [1.08; 1.20]; 1.33 [1.24; 1.42]; 1.39 [1.25; 1.54]; 1.61 [1.35; 1.93]). The risk rose more slowly when mRNA-based vaccines were used exclusively. In a previous study, we observed 82% initial efficacy in cases aged 60 and above who received a booster vaccination (compared to unvaccinated cases) and an absolute risk reduction of 2.1%. If one extrapolates these findings to the current study, the residual efficacy and absolute risk reduction are found to be approximately 71% and 1.8% (respectively) at 6 months, and 32% and 0.8% at 15 months. These results indicate that, during the Omicron wave, the protection of older persons against a severe COVID-19 course gradually declined from six months after vaccination onward. The limitations of this study include confounders that could not be taken into account, possible misclassification of the cause of death, and selection bias due to missing information about vaccination status and severe COVID-19 courses.

Identification of interrelated innate and sensitive immune responses in COVID-19 is an important step in the development of targeted therapeutic approaches, which is relevant. Objective. To clarify the features of the defect in the function of NK cells, T lymphocytes, the interferon system in patients with moderate and severe COVID-19. Patients and methods. Tests of the peripheral blood of 50 COVID-19 patients aged 61(57–71) and having the moderate and severe disease were performed. The following parameters were measured: the quantity of CD3+CD19–, CD3+CD4+, CD3+CD8+ T lymphocytes, NK – (CD3–CD16+CD56+), and TNK – CD3+CD16+CD56+ with expression density considered membrane receptors (MFI) (FC 500 Beckman Coulter, USA), the levels of IFN-α, IFN-γ, IL-6, TNF-α cytokines (IFA). Results. Combined immunodeficiency associated with quantitative and functional defects in NK, T lymphocytes and their subsets was revealed in moderate and severe COVID-19. An imbalance of cytokines has been established: blockade of the production of IFN-α and IFN-γ against the background of a significant increase in IL-6 and TNF-α, which negatively affects both the number and functionality of the participants in the immune response and is associated with a severe course and poor prognosis of COVID-19. Conclusion. The data obtained demonstrate the need to develop new strategies and tactics for the treatment of COVID-19, including replacement systemic therapy with recombinant IFN-α2b in combination with antioxidants (Viferon®) in adequate therapeutic doses, aimed at restoring the normal functioning of T lymphocytes, NK and the interferon system. Key words: COVID-19, interferons, moderate and severe disease course, NK cells, T lymphocytes

Актуальность: Коронавирусная инфекция — болезнь, вызывающая дыхательную недостаточность и осложнения у определенных групп людей, приводящие к смерти. Факторы, ассоциированные с тяжелым течением COVID-19, к текущему моменту достаточно хорошо изучены, в связи с чем, на современном этапе необходим их поиск и изучение в отдельных группах лиц, отличающихся по возрасту, полу, этнической принадлежности, наличию фоновых заболеваний и т.д. для разработки более персонализированных подходов к профилактике тяжелого течения. Цель исследования: провести сравнительный анализ факторов, ассоциированных с тяжелым течением COVID-19 у лиц до 60 лет и старше 60 лет и оценить их прогностическую значимость при комбинации факторов. Материалы и методы исследования: был проведен ретроспективный анализ клинических и лабораторных показателей 812 больных. Для идентификации факторов, ассоциированных с развитием тяжелого течения COVID-19, использовался множественный логистический регрессионный анализ. Для оценки прогностической значимости совокупности выявленных статистически значимых факторов в развитии тяжелого течения COVID-19 был проведен ROC-анализ. Результаты исследования: Многофакторный логистический регресионный анализ показал, что у больных до 60 лет диагноз сахарного диабета в анамнезе (OR=2,561, р=0,048), лимфопения (OR=2,133, p=0,030), наличие пневмонии при поступлении (OR=2,556, p=0,011), учащенное дыхание (OR=3,497, p=0,001), низкая сатурация (OR=4,076, p=0,006) были достоверно связаны с развитием тяжелого течения COVID-19. У больных старше 60 лет наличие сахарного диабета (OR=1,899, р=0,029), учащенное дыхание (OR=2,338, p=0,007) и низкая сатурация (OR = 4,248, p &lt;0,0001) были достоверно связаны с развитием тяжелого течения COVID-19. В группах до 60 лет и старше 60 лет прогностическое значение комбинации всех соответствующих группам статистически значимых факторов было равно среднему уровню (AUC=0,760 и AUC=0,709 соответственно). Заключение: Факторы, ассоциированные с развитием тяжелого течения COVID-19, у лиц пожилого и среднего возраста имеют некоторые отличия, связанные с особенностями патогенеза заболевания. Для лиц до 60 лет факторами, ассоциированными с тяжелым течением COVID-19, являются сахарный диабет, наличие пневмонии при поступлении, одышка, низкая сатурация и лимфопения. Для лиц старше 60 лет факторами, ассоциированными с тяжелым течением COVID-19, являются наличие сахарного диабета, одышка и низкая сатурация. Совокупность всех изученных факторов значительно повышает риск формирования тяжелого течения COVID-19 в обеих возрастных группах. Introduction: Coronavirus infection is a disease that causes respiratory failure and complications in certain groups of people, leading to death. The factors associated with the severe course of COVID-19 have been fairly well studied by now; at the present stage, it is necessary to search for and study them in separate groups of people that differ in age, gender, ethnicity, the presence of background diseases, etc. to develop more personalized approaches to severe disease prevention. Objective: To conduct a comparative analysis of the factors associated with the severe course of COVID-19 in people under and over 60 years of age and evaluate their prognostic significance in combination of factors. Materials and methods: A retrospective analysis of the clinical and laboratory parameters of 812 COVID-19 patients was carried out. Multiple logistic regression analysis was used to identify factors associated with the development of severe COVID-19. ROC analysis was performed to assess the prognostic significance of the set of identified statistically significant factors in the development of a severe course of COVID-19. Results: Multivariate logistic regression analysis showed that patients under 60 diabetes mellitus (OR=2,561, p=0,048), lymphopenia (OR=2,133, p=0,030), and pneumonia at admission (OR=2,556, p=0,011), rapid breathing (OR=3,497, p=0,001), low saturation (OR=4,076, p=0,006) were significantly associated with the development of severe COVID-19. At the same time, in patients older than 60 years, the presence of diabetes mellitus (OR=1,899, p=0,029), rapid breathing (OR=2,338, p=0,007) and low saturation (OR=4,248, p&lt;0,0001) were significantly associated with the development of a severe course of COVID-19. In groups under 60 and over 60 years of age, the prognostic value of the combination of all statistically significant factors corresponding to the groups was equal to the average level (AUC=0,760 and AUC=0,709, respectively) Conclusion: Factors associated with the development of a severe course of COVID-19 in elderly and middle-aged people have some differences related to the pathogenesis of the disease. For individuals under 60 years of age, factors associated with severe COVID-19 are diabetes mellitus, the presence of pneumonia on admission, dyspnea, low oxygen saturation, and lymphopenia. For individuals over 60 years of age, factors associated with severe COVID-19 are the presence of diabetes mellitus, shortness of breath, and low saturation. The combination of all the studied factors significantly increases the risk of developing a severe course of COVID-19 in both age groups. Кіріспе: Коронавирустық инфекция - бұл адамдардың белгілі бір топтарында тыныс алу жеткіліксіздігі мен асқынуларды тудыратын, өлімге әкелетін ауру. Қазіргі уақыттаCOVID-19 ауыр ағымына байланысты факторлар жеткілікті түрде зерттелді, осы кезеңде оларды жасы, жынысы, этникалық құрамы, фондық аурулар бойынша ерекшеленетін адамдардың жекелеген топтарында іздеу және зерттеу аурудың ауыр ағымының алдын алудағы жекелендірілген тәсілдерін әзірлеуге қажет. Зерттеу мақсаты: 60 жасқа дейінгі және 60 жастан асқан адамдардаCOVID-19 ауыр ағымымен байланысты факторларға салыстырмалы талдау жүргізу және факторлардың жиынтығымен олардың болжамдық маңыздылығын бағалау. Зерттеудің материалдары мен әдістері: 812 науқастың клиникалық және зертханалық көрсеткіштеріне ретроспективті талдау жасалды. Ауыр COVID-19 дамуына байланысты факторларды анықтау үшін бірнеше логистикалық регрессиялық талдау қолданылды. COVID-19 ауыр ағымының дамуындағы анықталған статистикалық маңызды факторлар жиынтығының болжамдық маңыздылығын бағалау үшінROC талдауы жүргізілді. Зерттеу нәтижелері: Көп нұсқалы логистикалық регрессиялық талдау60 жасқа дейінгі пациенттерде қант диабеті(OR=2,561, p=0,048), лимфопения (OR=2,133, p=0,030) және қабылдау кезінде пневмония (OR=2,556, p=0,011) болғанын көрсетті. жылдам тыныс алу(OR=3,497, p=0,001), төмен қанықтылық (OR=4,076, p=0,006) ауыр COVID-19 дамуымен айтарлықтай байланысты болды. 60 жастан асқан емделушілерде қант диабетінің болуы (OR=1,899, p=0,029), жылдам тыныс алу(OR=2,338, p=0,007) және қанығу деңгейінің төмендігі(OR=4,248, p&lt;0,0001) айтарлықтай дәрежеде байланысты болды. COVID-19 ауыр ағымының дамуы. 60 жастан кіші және60 жастан асқан топтарда топтарға сәйкес келетін барлық статистикалық маңызды факторлардың комбинациясының болжамдық мәні орташа деңгейге тең болды (тиісіншеAUC=0,760 және AUC=0,709). Қорытынды: Егде және орта жастағы адамдарда COVID-19 ауыр ағымының дамуына байланысты факторлар аурудың патогенезіне байланысты кейбір айырмашылықтарға ие. 60 жасқа толмаған адамдар үшін ауыр COVID-19-мен байланысты факторлар қант диабеті, қабылдау кезінде пневмонияның болуы, ентігу, оттегімен қанығудың төмендігі және лимфопения болып табылады. 60 жастан асқан адамдар үшін ауырCOVID-19-мен байланысты факторлар қант диабетінің болуы, ентігу және қанықтылықтың төмендігі болып табылады. Барлық зерттелген факторлардың қосындысы екі жас тобында да COVID-19 ауыр ағымының даму қаупін айтарлықтай арттырады.

Introduction: The relevance of the issue of human age-specific vulnerability to effects of environmental factors, especially biological agents, including viral infections, for public health is attributed to the aging of the population and the requirements for considering individual characteristics for a more accurate risk assessment. Objective: To establish age-specific patterns of the COVID-19 risk among healthcare and industrial workers. Materials and methods: We have analyzed the incidence and course of COVID-19 among 729 healthcare workers and 880 industrial workers in 2021–2022. The risk of mild, moderate and severe course of COVID-19 was determined in each age group. The age-specific dynamics of the COVID-19 risk was characterized by its change per year of age of the employees. Results: We established that the incidence of COVID-19 among healthcare workers was 1.6 times higher than among industrial workers. We also observed regularities of the age-specific dynamics of risk of COVID-19 of different severity among healthcare and industrial workers. For the mild course of the disease, the risk was approximated by the following regressions: healthcare Ri 1 (%) = –0.15 × (Age – 20, years) + 34.06; industry Ri 1 (%) = –0.24 × (Age – 20) + 27.21. For the moderate and severe course, the regressions were as follows: healthcare Ri 2,3 (%) = 0.23 × (Age – 20) + 2.46; industry Ri 2.3(%) = 0.14×(Age – 20) – 1.29. Conclusions: In different age groups, the relative risk of a mild course of COVID-19 in healthcare workers is 1.2–2.1 times higher than in industrial workers while that of a moderate and severe course is already 3 to 9 times higher. The direction of the age-specific COVID-19 risk depends on the disease severity. As for the mild course, a one-year increase in age is associated with a decrease in the disease risk by an average of 0.15 % in healthcare workers and 0.24 % in industrial workers. As for the moderate and severe courses, a one-year increase in age is associated with an increase in the COVID-19 risk by 0.23 % and 0.14 % in healthcare and industrial workers, respectively.

Patients with obstructive sleep apnoea (OSA) are at increased risk of severe course of COVID-19. Vaccination remains to be the most effective prevention of complicated courses of infection. The best contemporary conservative treatment of OSA is continuous positive airway pressure (CPAP) therapy. To compare vaccination acceptance and outcomes of COVID-19 infection between OSA patients adhering to the CPAP therapy and those who rejected CPAP and surgical therapy. Subjects were divided into two groups: group A (N = 167) were individuals with sufficient CPAP adherence (more than 4 hours per night on average) over the last 10 years. Group B (N = 106) were individuals who did not use the CPAP therapy at all and had no indications to surgical therapy. Three patients in group B died, and one had a severe course of COVID-19. None of the patients in group A died or experienced a severe course of COVID-19. Group A had a significantly higher proportion of males (77.8% compared to 66% in group B) and all parameters of OSA severity. The vaccination status was similar among both groups, with a complete triple dose vaccination rate of 69.5% and 67.9% in groups A and B, respectively. The results show that the patients with OSA adherent to CPAP therapy were less likely to experience a severe course of COVID-19 or death than the OSA patients non-compliant with therapy, despite the former group having more severe OSA. This result underlines the importance of adherence to CPAP therapy in OSA.

BACKGROUND: The new coronavirus infection (COVID-19) gained the pandemic status in 2020, and despite the fact that since then the virus has become less pathogenic, its virulence has increased by 2023. Well-vascularized organs and tissues, including the retina, represent the target for coronavirus. The etiopathogenesis of COVID-associated retinopathy, first described in 2021, still remains poorly understood, and its forms and occurrence frequency during different periods of the infectious process vary greatly. AIM: To identify the main characteristics of the COVID-associated retinopathy in patients with moderate and severe COVID-19 course during the acute period of the disease. MATERIALS AND METHODS: The study, conducted in 2021 (group 1) and 2023 (group 2), included patients with confirmed COVID-19 of moderate to severe course during the first 7 days from the onset of symptoms. Group 1 included 46 people, mean age 65.5 years, and group 2 included 55 people, mean age 69.3 years. The ophthalmologic examination was carried out in the “red zone” and intensive care unit, and included examination of the anterior segment of the eye, indirect ophthalmoscopy, and fundus photography using a portable hand-held digital fundus camera (Smartscope M5, Optomed, Finland). Hypertension, diabetes mellitus, volume of lung damage, invasive mechanical ventilation, and anticoagulant therapy were considered as conditions affecting retinal microcirculation. RESULTS: The observation groups were homogeneous in terms of gender, age, and concomitant diseases. The incidence of ophthalmoscopic findings in group 1 was 17.3%, and in group 2 — 12.7%. Most often, during the first 7 days of the disease, signs of angiopathy were observed: dilatation of blood vessels, irregularity of their diameter and tortuosity. Among focal changes, there were multiple retinal hemorrhages (6.5% and 3.6%) and cotton wool spots (4.3% and 5.4%). In patients with fundus changes, diabetes mellitus was significantly less common (in group 1, 25% vs. 39%, p 0.001; in group 2, 28% vs. 44%, p 0.001), as well as arterial hypertension (in group 1, 55% vs. 66%, p = 0.003; in group 2 28% vs. 83%, p 0.001). In group 1, there was a higher proportion of patients treated in intensive care unit, as in group 2 (37% vs. 17%, p 0.001), but in group 2, patients with identified retinal changes were more likely to receive therapeutic doses of anticoagulants (33% vs. 12%, p 0.001). CONCLUSION: The main characteristics of COVID-associated retinopathy in patients with moderate to severe COVID-19 during the acute period of the disease are dilatation and pathological tortuosity of the retinal arteries and veins, intraretinal hemorrhages and cotton wool spots. The connection between COVID-associated retinopathy and concomitant to the infectious process cardiovascular conditions has not been established. Retinopathy associated with coronavirus infection, with absolute similarity of clinical manifestations, was significantly more common in 2021 than in 2023.

Risk of Severe Sars-Cov-2 Infections in COVID-19 Vaccinated Individuals with Hematologic Malignancies (SAVE HEM): A Nationwide Cohort Study in the Netherlands

Amantadine has begun to be used as a possible alternative in COVID-19 therapy to mitigate its effects. There is anecdotal evidence that patients with Parkinson's disease (PD) treated with amantadine and who test positive for COVID-19 often do not develop clinical manifestations of COVID-19. Objective : to compare the clinical course of COVID-19 in patients with PD who took or did not take amantadine sulfate. Patients and methods . A prospective continuous study included 142 patients with PD who were treated in Republican Clinical Diagnostic Center for Extrapyramidal Pathology and Botulinum Therapy in Kazan from October 2021 to January 2022. Patients filled out a proprietary internally developed questionnaire. Results and discussion . Out of 142 individuals with PD COVID-19 occurred in 77 (54.2%), of which 52.0% had a mild course, 39.0% had a moderate course, 2.6% had a severe course, and in 6.5% the severity of the disease has not been established. Deterioration after COVID-19 infection was noted by 36% of patients: the appearance or increase in motor fluctuations (41%), increased tremor, stiffness or slowness (31%), the appearance of "exhaustion" of the effect of a single dose of levodopa (13%), the appearance or increased dyskinesia (21%), hallucinations (3.5%). Patients taking amantadine sulfate had PD much longer (11.5±5.62 years versus 5.12±3.24 years) and had a more pronounced (III–IV) stage of the disease. These patients were more likely to experience mild COVID-19 (in 60.87% of cases), in contrast to patients not receiving amantadine sulfate (only in 48.15% of cases). There was no correlation between the severity of COVID-19 and levodopa intake. Conclusion . The results of the study showed that patients with PD taking amantadine sulfate are more likely to have a mild course of COVID-19.

Dexamethasone and remdesivir: finding method in the COVID-19 madness

Abstract. The relevance of the study is due to the lack of data on the state of nonspecific cellular immunity in studies with sera and autostrains of S. aureus isolated from patients with allergic dermatoses, which would reflect the intensity of antimicrobial immunity in patients with allergic dermatoses, aggravated by staphylococcal infection, depending on the severity of dermatosis. The aim of the study was to determine and analyze the results of antimicrobial immunity indicators in patients with atopic dermatitis and true eczema, aggravated by staphylococcal infection, using sera and autostrains of S. aureus, depending on the severity of the disease. Material and methods. It was included 107 patients with different stage of the allergic dermatoses severity and control group of 15 healthy individuals to the research . The patients were divided into 3 groups in according to the severity of cutaneous process course. There were determined the basic indices of initial stages of phagocytosis and oxydepending bactericidal activity of the phagocytes. It was conducted the immunologic examinations using the autostrains patient from the locus morbi and standard strain S. aureus ATCC for the estimation of antimicrobial immunity. Results. Evaluation of phagocytosis indices in patients with allergodermatosеs showed a correlation between the severity of the disease course and the level of inhibition of the cellular level of nonspecific immunity. According to the results of studies using autostrains S. aureus, the most significant inhibition of phagocytosis (p ≤ 0,05), compared to the values of similar indicators in the control group of healthy individuals, it was found in the groups of patients with moderate and severe atopic dermatosis (AD) course, respectively: phagocytic activity (PhА) (78,1 ± 1,4) and (72,4 ± 1,4) and (71,7 ± 0,8) %; phagocytic number___ (PhN) (5,3 ± 0,2) and (4,3 ± 0,2) and (3,5 ± 0,1) absolute number (abs. num.); phagocytic index__ (PhI) (6,8 ± 0,2) and (6,2 ± 0,2) and (4,8 ± 0,1) abs. num.; phagocytic capacity (PhC) (30,3 ± 1,0) and (26,5 ± 1,8) and (22,6 ± 0,8) ×103 microbial cell /mm3; spontaneous test of the renovation of nitroblue tetrazolium (sNBT) (42,1 ± 1,3) and (48,1 ± 1,2) and (50,6 ± 0,3) %; induction test of the renovation of nitroblue tetrazolium (іNBT) (63,4 ± 1,6) and (53,4 ± 0,8) and (51,7 ± 0,7) %. In the patients with true eczema (TE), they revealed a similar regularity of phagocytosis inhibition, most pronounced in patients with a severe disease course (p ≤ 0,05), but with a slightly smaller degree of difference between the indicator values of phagocytosis compared with the group of healthy individuals, respectively: PhА (74,8 ± 1,3) and (78,1 ± 1,4) %; PhN (4,5 ± 0,1) and (5,3 ± 0,2) abs. num.; PhI (5,9 ± 0,2) and (6,8 ± 0,9) abs. num.; sНСТ (46,0 ± 0,6) and (42,1 ± 1,3) %; іНСТ (51,8 ± 0,8) and (63,4 ± 1,6) %. Conclusions. The results of identification of phagocytosis in patients with allergodermatosеs using the standard culture of S. aureus ATCC 25923 generally reflect the described regularities of inhibition in patients of the cellular level of nonspecific immunity, but are less presentable for their identification in comparison with the autostrains. Keywords: allergic dermatoses, severity of the course, S aureus autostrains, S. aureus ATCC 25923, antimicrobial resistance.

BackgroundInfection by the SARS-Cov-2 virus produces in humans a disease of highly variable and unpredictable severity. The presence of frequent genetic single nucleotide polymorphisms (SNPs) in the population might lead to a greater susceptibility to infection or an exaggerated inflammatory response. SARS-CoV-2 requires the presence of the ACE2 protein to enter in the cell and ACE2 is a regulator of the renin-angiotensin system. Accordingly, we studied the associations between 8 SNPs from AGTR1, ACE2 and ACE genes and the severity of the disease produced by the SARS-Cov-2 virus.Methods318 (aged 59.6±17.3 years, males 62.6%) COVID-19 patients were grouped based on the severity of symptoms: Outpatients (n = 104, 32.7%), hospitalized on the wards (n = 73, 23.0%), Intensive Care Unit (ICU) (n = 84, 26.4%) and deceased (n = 57, 17.9%). Comorbidity data (diabetes, hypertension, obesity, lung disease and cancer) were collected for adjustment. Genotype distribution of 8 selected SNPs among the severity groups was analyzed.ResultsFour SNPs in ACE2 were associated with the severity of disease. While rs2074192 andrs1978124showed a protector effectassuming an overdominant model of inheritance (G/A vs. GG-AA, OR = 0.32, 95%CI = 0.12–0.82; p = 0.016 and A/G vs. AA-GG, OR = 0.37, 95%CI: 0.14–0.96; p = 0.038, respectively); the SNPs rs2106809 and rs2285666were associated with an increased risk of being hospitalized and a severity course of the disease with recessive models of inheritance (C/C vs. T/C-T/T, OR = 11.41, 95% CI: 1.12–115.91; p = 0.012) and (A/A vs. GG-G/A, OR = 12.61, 95% CI: 1.26–125.87; p = 0.0081). As expected, an older age (OR = 1.47), male gender (OR = 1.98) and comorbidities (OR = 2.52) increased the risk of being admitted to ICU or death vs more benign outpatient course. Multivariable analysis demonstrated the role of the certain genotypes (ACE2) with the severity of COVID-19 (OR: 0.31, OR 0.37 for rs2074192 and rs1978124, and OR = 2.67, OR = 2.70 for rs2106809 and rs2285666, respectively). Hardy-Weinberg equilibrium in hospitalized group for I/D SNP in ACE was not showed (p<0.05), which might be due to the association with the disease. No association between COVID-19 disease and the different AGTR1 SNPs was evidenced on multivariable, nevertheless the A/A genotype for rs5183 showed an higher hospitalization risk in patients with comorbidities.ConclusionsDifferent genetic variants in ACE2 were associated with a severe clinical course and death groups of patients with COVID-19. ACE2 common SNPs in the population might modulate severity of COVID-19 infection independently of other known markers like gender, age and comorbidities.

The objective: to identify specific features of the COVID-19 course in HIV positive patients and risk factors for unfavourable outcomes in such patients.Subjects and Methods. Patients with COVID-19 regardless of their HIV status admitted to hospital were enrolled in a retrospective observational study.Results. HIV positive patients experienced a more severe course of COVID-19 including more extensive lung tissue damage and severe respiratory failure. Shortness of breath was more common of patients with HIV infection. Laboratory tests revealed adecreased antiviral immune response, signs of anemia and liver damage, and a tendency to develop blood clots. When developing a prognostic logistic regression model in patients with COVID-19 and HIV infection, it was revealed that the risk of an unfavorable outcome was associated with such factors as a decrease in the relative number of lymphocytes and level of total protein in peripheral blood at the moment of admission to hospital.Conclusions. Given the elevated risk of a severe course and unfavorable outcome of COVID-19 in case of concurrent HIV infection, it is necessary to monitor symptoms of respiratory failure in these patients, and if they appear, make a decision about hospitalization at an earlier stage of the disease.

ABSTRACT. Among residents of Chernivtsi region, the main characteristics, frequency and peculiarities of the occurrence of long-term symptomatic and post-COVID-19 syndrome have not been sufficiently elucidated. The goal of the study was set: to evaluate the options for the course of the post-covid syndrome depending on age, gender, comorbidity and severity of the course of COVID-19. Material and methods. The following research methods were used: electronic questionnaire, epidemiological, clinical and anamnestic, analytical and statistical methods. The study included 214 adult patients who were infected with the SARS-CoV-2 virus (the diagnosis was confirmed by PCR) and who suffered from COVID- 19 of varying degrees of severity and were randomized into two groups: the 1st group (main) included – 112 people (ratio of men/women - 56.4 % (n = 63): 47.5 % (n = 49)), comparative (102 people) – patients with a mild and moderate course of COVID-19 who were consulted and were treated on an outpatient basis (male/female ratio – 45.5 % (n = 46): 54.5 % (n = 56)). Statistical processing of the data obtained during the research was carried out using the IBM SPSS Statistics v26.0 program. Results. It was found that among inpatients there was a significantly significant number of patients older than 60 years old (p &lt; 0.001), whereas among outpatients there were significantly more patients aged 18-29, which indicates a connection between the age of the respondents and the need for inpatient treatment presence of COVID-19. In the main group, the following symptoms occurred more frequently (p &lt; 0.05): cough OR = 2.023 [CI 1.105-3.703], fever OR = 6.916 [CI 2.061-23.204], difficulty breathing (dyspnea) OR = 4.421 [2.230 -8.764]. In the comparison group, the following prevailed: loss of smell OR = 0.147 [CI 0.077-0.281], fatigue OR = 0.456 [CI 0.226-0.920], increased temperature OR=2.023 [2.061- 23.204]. With a higher frequency, such diseases as: coronary heart disease (OR = 33.088 [CI 9.444-115.930]), arterial hypertension (OR = 13.641 [CI 6.547-28.422]), diabetes (OR = 4.755 [CI 1.915-11.803]), heart failure (OR = 18.504 [CI 8.200-41.752]), obesity (OR = 4.828 [CI 2.433-9.581]). Conclusions. 1. Among the patients who received inpatient treatment, the vast majority were people over 40 years old, younger men (from 40 years old) were more likely than women (over 60). 2. In persons with a severe course of COVID-19, the frequency of symptoms of shortness of breath, cough, difficulty breathing, chest pain is more likely to be registered, and in outpatients - loss of smell and fatigue. 3. With a greater frequency, such diseases as: coronary heart disease (37.5 %), arterial hypertension (57.4 %), diabetes (21.3 %), heart failure (54,1 %), obesity (41.1 %). Smoking and alcohol abuse did not show significant reliable differences. 4. The combination of 3 pathologies (hypertension, heart failure, obesity) was most common - in 11 people (10 %).

Old age, obesity and vitamin D deficiency are considered as independent risk factors for severe courses of COVID-19. The aim of the review is to discuss common features of these risk factors and the impact of vitamin D. The recently discovered relationship between vitamin D and the infection pathway of the virus via the renin--angiotensin system (RAS) and the adipokines leptin and adiponectin play an important role. The frequency of studies showing a relationship between a low vitamin D status in comorbidities and severe COVID-19 courses makes an impact of vitamin D effects likely. There is a direct relationship between vitamin D, body fat and age in COVID-19 courses. With age, the ability of the skin to synthesize vitamin D decreases, and leads to vitamin D-deficits. If the skin is insufficiently exposed to sunlight, severe deficits can develop. As vitamin D plays an important role not only in the immune system but also in the RAS, and thus at the point where the virus attacks, a good vitamin D supply is an important basis for reducing the risk of severe COVID-19 processes. Treatment with vitamin D supplements should be based on severity of the vitamin D deficiency.