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Purpose of the work: to study liver elasticity indicators, hydrogen and methane levels in exhaled air, and their associations with clinical and biochemical parameters for patients who underwent COVID-19. Materials and methods. We examined 30 patients (mean age 51.8±2.91) who underwent COVID-19 (confirmed by SARSCoV-2 RNA test or SARS-CoV-2 antigen) 12-16 weeks after the onset of the first symptoms, of which 11 were diagnosed with pneumonia. 19 people (mean age 47.1±3.09) who did not have COVID-19 made up the comparison group. The patients underwent a clinical and biochemical study, the degree of liver fibrosis was determined (FibroScan® 502 Echosens, France), the levels of hydrogen (H2) and methane (CH4) in the exhaled air were measured (baseline and after taking lactulose solution) (GastroCheck Gastrolyzer, Bedfont Scientific Ltd., England). Results. Past COVID-19 infection was directly correlated with age (r=0.331, p=0.022), male gender (r=0.324, p=0.025), and presence of liver fibrosis (r=0.291, p=0.044). COVID-19 survivors were more likely to have liver fibrosis (p<0.001) and higher liver elasticity in kPa (p=0.018) with overweight and obesity (63.3%) and elevated body mass index (p= 0.03) compared with the control group. The presence of liver fibrosis was associated with moderate pneumonia (p<0.001). Among those who had COVID-19, there were significantly more non-producers of methane (p=0.02), fewer people with an average level of methane in exhaled air (p=0.016). In COVID-19 convalescents, bacterial overgrowth syndrome (BOS) was detected less frequently than in controls (p=0.04), but signs of delayed intestinal transit were more often recorded (p<0.05). The presence of liver fibrosis in survivors of COVID-19 is associated with BOS detection (23.3% vs. 5.2%, p<0.001), which probably contributes to the pathogenesis of liver damage. Hydrogen levels at 120 min and methane at 60 min after ingestion of lactulose solution distinguished between COVID-19 convalescents and COVID-19 survivors with an AUC of 0.683 and 0.660, respectively. The associations of the levels of gases in the exhaled air with clinical and biochemical parameters were revealed: the presence of overweight and obesity showed inverse associations with the level of methane production (r= -0.342, p<0.05), its concentration after taking lactulose at various time intervals, and also the basic level of hydrogen (r= -0.313, p<0.05);the degree of obesity was also inversely correlated with the level of methane emission (r= -0.368, p=0.038). Direct links were established between indicators of liver elasticity in kPa and the level of hydrogen production (r=0.275, p<0.05). Conclusions. Obtained indirect signs of pronounced changes in the intestinal microbiome, which obviously contribute to a more severe course of COVID-19, the development of liver fibrosis, so the impact on the intestinal microflora can be considered as a potential target in the treatment of patients with COVID-19. © 2022 Kola Science Centre of the Russian Academy of Sciences. All rights reserved.
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Erythrocytes of 40 patients (11 men and 29 women, average age 52.2 +/- 13.2 years), COVID-19 convalescents (within 2 - 4 months after the disease), were studied by dielectrophoresis using an electro-optical cell detection system in a nonuniform alternating electric field. Cytoflavin at a concentration of 1:30 (v:v) after incubation with erythrocytes (1,6 - 1,8 x 108/ml) for 10 minutes caused an increase by 24 - 63% on average in the share of discocytes, amplitude of deformation, speed of cell movement towards electrodes, magnitude of the dipole moment, capacity of the erythrocyte membranes, and in the polarizability at a frequency of 106 Hz and relative polarizability (p = 0.05 - 0.0001). On the contrary, a decrease by 27 - 49% on average is observed in the composite indicators of viscosity, cell rigidity, electrical conductivity, aggregation index, degree of hemolysis at different frequencies of the electric field (p = 0.05 - 0.002). A shift of the crossover frequency of erythrocytes (from the position of the frequency regions of negative and positive dielectrophoresis) to the low-frequency range is revealed (p < 0.0001). The analysis of data using the Volcano-plot method (paired and unpaired statistics) showed that the degree of erythrocyte deformation at a frequency of 0.5 . 106 Hz, relative polarizability, the position of the crossover frequency, membrane capacity and polarizability of cells at different frequencies of the electric field appeared to be the most sensitive to the action of cytoflavin. Thus, the action of cytoflavin triggers the processes optimizig the rheological properties of erythrocytes of patients underwent COVID-19 which is rather important for adequate micro- and macrocirculation of blood and allows expanding indications for the use of the drug in patients of this category. Copyright © 2022 Izdatel'stvo Meditsina. All rights reserved.
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Objective: The purpose is to identify the peculiarities of the parameters of red blood cells (RBC) and hemostasis in patients with strokes associated with coronavirus infection. Design and method: A total of 124 patients (48.5 + 1.9 years) with impairments of cerebral circulation due to COVID-19 (confirmed by positive PCR test) had been examined. Among them, 74 patients had ischemic stroke, 25- transient ischaemic attack, 17- intracerebral hemorrhage, 8- subarachnoid hemorrhage. The parameters of hemostasis were measured by standard methods, electrical, viscoelastic parameters of RBC - by dielectrophoresis. Results: 71 patients (the 1st group) showed signs of intravascular coagulation and thrombosis: accelerated platelet-leukocyte aggregation, increased levels of coagulation products, reduced fibrinolysis activity (p = 0.001-0.04). The levels of D-dimer, fibrinogen, ESR, platelet count were higher in this group compared to the second one (p < 0.01). A moderate increase of RBC summarized rigidity, viscosity was noted. The level of RBC hemolysis was associated with platelet count (r = 0.735,p = 0.03), D-dimer (r = 0.482, p < 0.05), fibrinogen level (r = 0.374, p = 0.04). In 2nd group (53 persons), the markers of thrombosis had moderate deviations. Sharply reduced RBC deformability with increased summarized rigidity, viscosity was dominant coupled with the background of high electrical conductivity of cell membranes compared to the indicators in the 1st group (p < 0.01). There was a decrease of membrane capacity, surface charge, cell dipole moment, polarizability than those in the 1st group (p = 0.0001-0.05). A sharp decrease of RBC deformability creates obstacles to overcoming small-diameter capillaries, leading to violations of microcirculatory blood flow. RBC deformability was associated with levels of ferritin (r = 0.451, p = 0.02), HbA1c (r = 0.480, p = 0.03), uric acid (r = -0.371, p < 0.05), LDL cholesterol (r = 0.461, p = 0.02). Incubation of blood samples in vitro for 10 min with riboflavin, nicotinamide, inosine, which ensures RBC energy metabolism, restored the reduced RBC deformability (p < 0.01), altered cell morphology (p = 0.04), decreased RBC aggregation (p < 0.001). Conclusions: The revealed features of parameters of RBC hemostasis in stroke patients with coronavirus infection are associated with two independent pathogenetic mechanisms: thrombotic and hemorheologic. The thrombotic variant is due to procoagulant state and an activity of inflammation. The hemorheologic variant is caused by decrease of RBC energy metabolism, activity of enzymes.
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The 2020 coronavirus infection pandemic has potentiated a large number of studies in the world on the etiopathogenesis, clinical and morphological manifestations of COVID-2019 infection. This review presents biochemical, molecular genetic and clinical aspects of COVID-2019. © 2021 Siberian State Medical University. All rights reserved.