ANALYSIS OF MORTALITY AMONG PATIENTS SUFFERING FROM HEART FAILURE, USING THE EXAMPLE OF A MEGALOPOLIS

The medical documentation (n = 146912) introduced into the system "Regional fragment of the unified state information system in the field of healthcare” of Saint Petersburg for 2019–2021 was analyzed. To evaluate the mortality of patients due to heart failure, all deceased patients from 2019 to 2021 in Saint Petersburg (n = 192133) were taken as a basis, and based on a thorough study of medical documentation, patients who died from cardiovascular diseases and because of heart failure were singled out separately. The total mortality from all causes in Saint Petersburg in 2019 was 53025 people;in 2020, 66468 people;and in 2021, 72640 people. The analysis of mortality due to cardiovascular diseases from 2019 to 2021 showed an upward trend of 20.1% over the 3-year period of data analysis. When analyzing the prevalence of heart failure among deceased patients, an increase of 129.4% was noted over this period. The obtained results of the prevalence, mortality, and mortality of patients due to heart failure on the example of a megalopolis are the most relevant at the current time;they indicate a steady increase in the number of patients suffering from heart failure with an increase in the burden on the city's healthcare system. Simultaneously, there is insufficient continuity in the provision of medical care to patients suffering from heart failure, which is because of not only a shortage of medical personnel at all stages of medical care but also insufficient compliance of patients who either do not want to be treated or cannot continue treatment. Moreover, a significant disconnect was found in the continuity of medical care at the stages of pre-hospital and hospital treatment, as well as further outpatient follow-up of patients suffering from heart failure in the metropolis. All this leads to a significant increase in the mortality and mortality of patients suffering from heart failure, despite all the existing modern effective drug therapies. It appears critical to create a unified register platform for recording patients with heart failure, which will allow for a more accurate understanding of epidemiological aspects, the solution of which will improve the quality of medical care, identify the need for the crucial medicines, and reduce mortality, and mortality rates due to heart failure. All rights reserved © Eco-Vector, 2022.

Monkeypox (mpox) is a new problem on a global scale for humanity.

Purpose - to draw attention to an infection that was little known, but has now become a global problem for society;to familiarize readers with the peculiarities of the 2022 monkeypox outbreak and to increase the level of alertness of doctors to this disease. Monkeypox is a global problem because the disease is spreading rapidly, covering 111 countries. Three cases were diagnosed in Ukraine. It is predominantly a self-limited infection, but there are severe and deadly complications. The lethality of this disease ranges from 0% to 11%. The course of the disease is more severe in children and people with reduced immunity. Vertical transmission of the virus from mother to child is possible, resulting in congenital monkeypox. Monkeypox is a zoonotic disease and its natural reservoir is not exactly known, but rodents are most likely to act. In most cases, person-to-person transmission of the virus occurs through close skin to skin contact, often during sexual intercourse. At the beginning of the outbreak 98% of cases of disease were was diagnosed in homo- and bisexuals. Airborne transmission is also possible. Infection is possible through close contact with infectious skin lesions. Clinically, the initial period resembles influenza, but lymphadenopathy is characteristic, which is considered a pathognomonic symptom of mpox. The rash is similar to that of chickenpox, but with more prevalent location on palms and soles than in chickenpox. In the presence of a vesicular rash in a patient, it is necessary to exclude monkeypox. PCR diagnostics of the virus in samples of vesicles or crusts has the greatest diagnostic value. Hygienic skin care is important. Antiviral drugs (tecovirimat, brincidofovir) are recommended only in severe cases. To reduce the spread of infection, international rules apply as for other infections, such as COVID-19. The monkeypox virus vaccine is recommended primarily for groups at risk of infection, including medical personnel who may come into contact with the patient or samples for laboratory testing. Being aware for this infection, following international health regulations, it is possible to prevent the further spread of monkeypox.Copyright © 2023 Tomsk State University. All rights reserved.

The Impact of Vaccination on COVID-19 Burden of Disease in the Adult and Elderly Population: A Systematic Review of Italian Evidence.

COVID-19 is a major global health threat, with millions of confirmed cases and deaths worldwide. Containment and mitigation strategies, including vaccination, have been implemented to reduce transmission and protect the population. We conducted two systematic reviews to collect nonrandomized studies investigating the effects of vaccination on COVID-19-related complications and deaths in the Italian population. We considered studies conducted in Italian settings and written in English that contained data on the effects of vaccination on COVID-19-related mortality and complications. We excluded studies that pertained to the pediatric population. In total, we included 10 unique studies in our two systematic reviews. The results showed that fully vaccinated individuals had a lower risk of death, severe symptoms, and hospitalization compared to unvaccinated individuals. The review also looked at the impact of vaccination on post-COVID-19 syndrome, the effectiveness of booster doses in older individuals, and nationwide adverse events. Our work highlights the crucial role that vaccination campaigns have played in reducing the burden of COVID-19 disease in the Italian adult population, positively impacting the pandemic trajectory in Italy.

Acute care treatment of COVID-19 pneumonia with acute respiratory failure

Treatment of COVID-19 patients and their extreme numbers represented an unprecedented challenge for the intensive care system in healthcare facilities throughout the Czech Republic, a country particularly affected by the new coronavirus SARS-CoV-2 pandemic. A steep increase in the need for intensive care placed an excess burden on bed and staff capacity. For a severe and critical course of COVID-19, bilateral pneumonia with acute hypoxemic respiratory failure is pathognomonic. In the intensive care setting, COVID-19 therapy is primarily symptomatic, supporting failing respiratory function to gain time needed to restore it and to repair the lungs. The aggressiveness and comprehensiveness of respiratory support depend on the severity of failure, ranging from simple oxygen therapy, to non-invasive support and mechanical ventilation, to extracorporeal support. By contrast, specific COVID-19 therapy is directly targeted against SARS-CoV-2 or modulates the organism's response to the virus. Primary, virus-induced lung injury may be secondarily complicated by coinfection or superinfection, most commonly bacterial, increasing the severity and lethality of the disease. Therefore, anti-infective therapy is crucial for the prognosis and outlook of intensive care COVID-19 patients. Among nosocomial infections com-plicating COVID-19, ventilator-associated pneumonia (developing in mechanically ventilated patients) is particularly important and challenging, and so are issues related to bacterial resistance and rational antibiotic therapy.Copyright © 2021, Trios spol. s.r.o.. All rights reserved.

Analysis of deaths during the first wave of a new coronavirus infection - COVID-19

The aim - study the main causes and factors that led to the death of patients with pneumonia from a new coronavirus infection (COVID-19) in a hospital setting. Material and methods. Analysis of 84 case histories with fatal outcomes, as well as postmortem examination of 6 deceased patients. Results and discussion. Comparative analysis of overall mortality rates by nosology among the population for the period 2019-2020 (n=33 537;36 299) shows that in 2020 the number of patients who died from respiratory diseases increased 2.1 times or 106%, from infectious and parasitic diseases - 1.3 times or 30.8%. The first case of infection with a new coronavirus infection (COVID-19) among citizens of the Republic of Tajikistan was registered on April 30, 2020, it was then that a quarantine restrictions was announced in the country. The peak of infection in Tajikistan fell in mid-May and the first ten days of June 2020, when from 80 to 210 patients were registered per day. In Tajikistan, since January 10, 2021, no cases of COVID-19 have been officially registered. As of January 30, 2021, the number of people infected with COVID-19 in the country was 13 308, of which 13 218 (99.3%) people were cured, 90 (0.68%) people died. The number of cases of pneumonia in the first 10 months of 2020 compared to 2019 increased from 12 802 to 18 504 people, or by 5702, and the number of deaths - from 129 to 291, that is, 2.3 times or 125.6%. At the same time, 10 606 cases of COVID-19 associated with pneumonia were registered in Tajikistan during this period, which amounted to 57.3% of the total number of cases. An analysis of the history of the deceased showed that in 4.3% of cases the age of the deceased was from 30 to 39 years, in 30.4% - from 40 to 60 years and in 65.3% - over 61 years. Conclusion. The analysis of deaths among the population of Tajikistan shows that in 2020 there was an increase in the mortality rate, the incidence of seasonal pneumonia and the number of patients with COVID-19 associated with pneumonia.Copyright © 2021 Sovero Press Publishing House. All rights reserved.

Impact of Hiv Infection on Mpox-Related Hospitalizations in Brazil

Background: Late presentation to care remains a major public health problem in Brazil, despite the countrys longstanding commitment to universal access to ART to all PLWH. The COVID-19 pandemic severely hit the country and further impacted the HIV care continuum, with worse disparities observed by gender and sexual orientation. By December 28th 2022, Brazil reported 10,493 and 14 mpox cases and deaths ranking second globall. Although mpox lethality is low, HIV-related immunosuppression may negatively impact mpox outcomes, increasing hospitalizations and fatalities. We aim to describe mpox hospitalization rates and explore the impact of HIV-infection on mpox-related hospitalizations and clinical outcomes. Method(s): Prospective, observational cohort study of individuals with confirmed mpox infection followed at the major mpox referral center in Rio de Janeiro, Brazil. Demographic and clinical data including reasons for hospitalization were systematically collected. Chi-squared or Fisher's exact tests for qualitative variables and the Moods median test for quantitative variables were used. Result(s): From June 12 to December 12, 2022, 402 participants had a laboratory-confirmed mpox diagnosis. Median age was 34 years, 365 (91%) were cisgender men, and 197 (49%) were PLWH. Overall, 39 (10%) participants were hospitalized due to mpox-related causes;20 (51%) were PLWH. All PLWH with CD4 counts< 200 cells/mm3 required hospitalization. Compared to nonhospitalized PLWH, a higher proportion of hospitalized PLWH had concomitant opportunistic infections (4/20 [20%] vs. 1/177 [0.6%];p< 0.001), were not virologically suppressed (7/20 [35.0%] vs. 22/177 [15.3%];p=0.1) and were not on ART (4/20 [20%] vs. 15/177 [7.6%];p=0.03). Among all hospitalized participants, PLWH were more frequently hospitalized due to severe proctitis than HIV-negative participants (12/20 [60%] vs. 5/19 [26.3%];p=0.03), with no differences regarding hospitalizations for pain control (Table). PLWH accounted for all cases of hospitalized individuals who required intensive care support (n=4), had deep tissue involvement (n=3) and had a mpox related death (n=2). Conclusion(s): Our findings suggest an association between worse outcomes in the HIV care continuum and mpox-related hospitalizations. Advanced immunosuppression (CD4< 200) contributed to more severe clinical presentations and death. Public health strategies to mitigate HIV late presentation and the negative impact of the COVID-19 pandemic to the HIV care continuum are urgently needed. Sociodemographic and clinical characteristics of mpox cases according to HIV and hospitalization status.

Targeting virus-induced vulnerabilities using synthetic lethality as a new class of host-based antivirals

RNA viruses are the major class of human pathogens responsible for many global health crises, including the COVID-19 pandemic. However, the current repertoire of U.S. Food and Drug Administration (FDA)-approved antivirals is limited to only nine out of the known 214 human-infecting RNAviruses, and almost all these antivirals target viral proteins. Traditional antiviral development generally proceeds in a virus-centric fashion, and successful therapies tend to be only marginally effective as monotherapies, due to dose-limiting toxicity and the rapid emergence of drug resistance. Host-based antivirals have potential to alleviate these shortcomings, but do not typically discriminate between infected and uninfected cells, thus eliciting unintended effects. In infected cells where host proteins are repurposed by a virus, normal host protein functions are compromised;a situation analogous to a loss-of-function mutation, and cells harboring the hypomorph have unique vulnerabilities. As well-established in model systems and in cancer therapeutics, these uniquely vulnerable cells can be selectively killed by a drug that inhibits a functionally redundant protein. This is the foundation of synthetic lethality (SL). To test if viral induced vulnerabilities can be exploited for viral therapeutics, we selectively targeted synthetic lethal partners of GBF1, a Golgi membrane protein and a critical host factor for many RNA viruses including poliovirus, Coxsackievirus, Dengue, Hepatitis C and E virus, and Ebola virus. GBF1 becomes a hypomorph upon interaction with the poliovirus protein 3A. A genome-wide chemogenomic CRISPR screen identified synthetic lethal partners of GBF1 and revealed ARF1 as the top hit. Disruption of ARF1, selectively killed cells that synthesize poliovirus 3A alone or in the context of a poliovirus replicon. Combining 3A expression with sub-lethal amounts of GCA - a specific inhibitor of GBF1 further exacerbated the GBF1-ARF1 SL effect. Together our data demonstrate proof of concept for host-based SL targeting of viral infection. We are currently testing all druggable synthetic lethal partners of GBF1 from our chemogenomic CRISPR-screen, in the context of dengue virus infection for their abilities to selectively kill infected cells and inhibit viral replication and infection. Importantly, these SL gene partners of viral-induced hypomorphs only become essential in infected cells and in principle, targeting them will have minimal effects on uninfected cells. Our strategy to target SL interactions of the viral-induced hypomorph has the potential to change the current paradigm for host-based therapeutics that can lead to broad-spectrum antivirals and can be applied to other intracellular pathogens. This work is supported by National Institutes of Health grants R01 GM112108 and P41 GM109824, R21 AI151344 and foundation grant FDN-167277 from the Canadian Institutes of Health Research.Copyright © 2023 The American Society for Biochemistry and Molecular Biology, Inc.

Impact of COVID-19 pandemic in solid organ transplant in Bogota, Colombia

Introduction: During the COVID-19 pandemic the number of solid organ transplants (SOT) lessened globally due probably to decreased donation and detour of resources to other prioritized activities [1, 2]. The aim of this paper is to analyze the SOT behavior during the COVID- 19 pandemic in this city. Method(s): An exploratory analysis was performed on the data of the Statistics on donation and transplant of organs and tissues in Bogota from 2018 until the third trimester of 2022 [3]. Result(s): 416 SOT from 365 organ donors were performed in Bogota during 2018. The first COVID-19 case in Colombia was documented in March 2020. During the following two years there was a decline in the number of performed SOT and total organ donors, as shown in Table 1. During 2020 there was a drastic reduction on the total SOT, compared with 2018. During 2021 there was a slight recovery in the total SOT, and in the first three trimesters of 2022 there was a drastic increase in the total SOT with 380 procedures performed and 380 organ donors. There was a steeper reduction in the number of heart and lung transplants during 2020 and 2021. The SOT waiting lists remained stable from 2018 to 2022, with 1804 patients in 2021, up to 1950 patients in 2022. Conclusion(s): The reduction in SOT might be due to COVID-19 in donors, reduced incidence of brain death and lessened capability to preserve viable organ donors. The SOT waiting list didn't increase possibly caused by high mortality due to end-stage organ failure. The SOT increase during 2021 coincides with a decrease in COVID-19 lethality in Bogota. This decline in SOT was observed globally during 2020, whilst the rapid recovery in SOT and availability of organ donors during 2022 is a phenomenon that has not been described yet to our knowledge.

The Problem of Home Therapy during COVID-19 Pandemic in Italy: Government Guidelines versus Freedom of Cure?

After starting in late 2019, COVID-19 spread worldwide, and Italy was one of the first Western nations to be seriously affected. At that time, both the virus and the disease were little known and there were no Evidence-Based Medicine indications for treatment. The Italian Health Ministry guidelines claimed that, unless oxygen saturation fell to <92%, no pharmacological treatment was necessary during the first 72 hours, other than on a purely symptomatic basis, preferably with paracetamol. As later confirmed, that delay in therapeutic intervention may have been responsible for numerous hospital admissions and a very high lethality (3.5 %). To try to remedy this situation, several volunteer groups were formed, managing to promptlycure thousands of patients at home with non-steroidal anti-inflammatory drugs and a variety of re-purposed drugs (principally hydroxychloroquine, ivermectin) and supplements (such as antioxidants, polyphenols and vitamin D). Although not documented by any randomized controlled studies, these approaches were nonetheless based on the best available evidence, were aimed at addressing otherwise unmet major needs and produced a significant reduction of hospitalizations, of symptom duration, and a complete recovery from the disease compared with late treatment, according to some retrospective observational studies and the clinical experience of many physicians. A prompt discussion, with a clear and open exchange between healthcare Institutions and the said groups of voluntary physicians, could clarify the most effective approaches to reduce the number of hospitalizations and the lethality of this disease.

Microbiological monitoring of COVID-19 patients in the ICU: a prospective observational study.

Objective. To study spectrum of pathogens and the time to colonization of respiratory samples in patients with severe and critical COVID-19 as well as to analyze incidence of nosocomial infections and structure of prescribed antibacterial drugs. Materials and methods. The prospective observational study included patients aged 18 years and older with confirmed severe and critical COVID-19 from December 2021 to February 2022. During the first 48 hours and then every 2-3 days of hospitalization, a respiratory sample was collected: sputum, tracheal aspirate (if intubated), bronchoalveolar lavage (if bronchoscopy was performed) for microscopy and microbiological examination. Some patients were screened for invasive aspergillosis. Clinical and demographic data, comorbidities, pathogenetic therapy for COVID-19, antibiotic therapy, cases of probable/documented bacterial nosocomial infections, antibiotic-associated diarrhea, and hospital treatment outcomes were recorded. Results. A total of 82 patients were included in this study. Patients with lung parenchyma involvement of more than 50% by computer tomography predominated;most of them (77%) required intubation and mechanical ventilation due to progression of respiratory failure, and 76% of patients had a lethal outcome. During the first 48 hours, a respiratory sample was obtained from 47 patients;the rest of the patients presented with non-productive cough. No growth of microorganisms was detected in 31 (36.8%) cases;clinically significant pathogens were detected in 16 (19.5%) patients. A subsequent analysis included data from 63 patients with a sufficient number of samples for dynamic observation were used. During the first 3 days of ICU stay, the most common bacterial pathogens were Klebsiella pneumoniae without acquired antibiotic resistance and methicillin-susceptible Staphylococcus aureus. From 3rd day and afterwards, an increase in the proportion of Acinetobacter baumannii, other non-fermenting bacteria, and carbapenem-resistant Enterobacterales was noted. Among the pathogens causing lower respiratory tract infections, A. baumannii and carbapenem-resistant K. pneumoniae were predominant pathogens and accounted for 76% of cases. Positive galactomannan test results were obtained in 4 cases. Conclusions. The study confirmed importance of bacterial nosocomial infections in patients with severe and critical COVID-19. In the case of the development of nosocomial lower respiratory tract infections, empirical antimicrobial therapy should take into account the predominance of carbapenem-resistant Enterobacteria and A. baumannii, as well as the possibility of invasive aspergillosis.Copyright © 2022, Interregional Association for Clinical Microbiology and Antimicrobial Chemotherapy. All rights reserved.

Are allergic diseases a risk factor for more severe COVID-19?

Background: The vast majority of studies indicate that asthma and allergic diseases are not risk factors, neither for COVID-19 susceptibility nor to cause a more severe course of disease. The study aimed to compare medical history, clinical characteristics, and outcome of COVID-19 in patients with allergic comorbidities and in general hospitalized population. Method(s): The study was a single-center retrospective analysis based on data of 632 COVID-19 patients admitted to the City Hospital No 4 (Dnipro) from August to October 2021. The patients' demographics, medical history, particularly the presence of allergic diseases, symptoms and lab tests on admission were collected from medical cards and analyzed. The methods of descriptive and non-parametric statistics were used to process the results. Result(s): Among 632 COVID-19 patients, 27 (4.3%) had the allergic diseases and reactions in medical history (Figure 1). Their median age was 60 (52;69) (p > 0.1), 21 (78%) were women (p = 0.072). The information concerning patients' demographics and clinical characteristics on admission is presented in Table 1. Conclusion(s): The hospitalized patients with COVID-19 and allergic diseases did not differ by from the general population with COVID-19. The Severity Index and lethality weren't higher in patients with allergies. At that time the frequency of saturation < 90% as key indicators of respiratory failure were lower in patients with allergic diseases. While there wasn't difference in need for supplemental oxygen support, interestingly, that there were less patients admitted to ICU in comparison with the general population. Thus, allergic diseases, at least, are not a risk factor for more severe COVID-19.

Les indicateurs d'alerte et de surveillance de la Covid-19

Face à la crise sanitaire provoquée par la pandémie de Covid-19 en France, Santé publique France a mis en place un système de surveillance évolutif fondé sur des définitions de cas possible, probable et confirmé. Le décompte quotidien se limite cependant aux cas confirmés par reverse transcriptase polymerase chain reaction ou sérologie SARS-CoV-2 (actuellement via la plateforme SI-DEP), aux cas hospitalisés (via le Système d'information pour le suivi des victimes d'attentats) et aux décès hospitaliers par Covid-19. Ce suivi de la circulation virale est forcément non exhaustif, et l'estimation de l'incidence est complétée par d'autres indicateurs comme les appels au 15, les recours à SOS Médecins, les passages dans les services d'accueil des urgences, les consultations de médecine de ville via le réseau Sentinelle. Le suivi de la mortalité non hospitalière s'est heurté aux délais de transmission des certificats de décès et au manque de diagnostic fiable. Seule la létalité hospitalière a pu être mesurée de manière fiable. Moyennant un certain nombre de précautions statistiques et d'hypothèses de travail, les modèles ont permis d'anticiper l'évolution de l'épidémie à partir de deux indicateurs essentiels : le ratio de reproduction R et le temps de doublement épidémique. En Île-de-France, l'Assistance publique– Hôpitaux de Paris a complété ce tableau de bord grâce à son entrepôt de données de santé et a ainsi pu modéliser de manière fine le parcours de soins des patients. L'ensemble de ces indicateurs a été essentiel pour assurer une planification de la réponse à la crise.Alternate abstract: Facing the arrival of the COVID-19 pandemic in France, Santé Publique France has set up an evolutionary surveillance system based on definitions of possible, probable and confirmed cases. But only cases confirmed by SARSCoV-2, RT-PCR (reverse transcriptase polymerase chain reaction) or serology, hospitalized cases and in-hospital deaths have been recorded on a daily basis. COVID-19 actual incidence has thus been estimated through additional indicators such as specific calls to emergency services (Samu) and SOS doctors, emergency rooms visits, or consultations in a sentinel network of general practitioners. Surveillance of non-hospital mortality has been impaired by delays and diagnostic inaccuracies of death certificates. Only in-hospital lethality could be reliably monitored.With a few essential statistical precautions and working hypotheses, models made it possible to anticipate the evolution of the epidemic based on two essential indicators: the reproduction ratio R, and the epidemic doubling time. In Ile-de-France region, the Greater Paris University Hospitals Group has used its data warehouse to complete this epidemic dashboard, including a fine modeling of patients' care pathways. All these indicators have proved essential to plan the response to this unprecedented crisis.

Features of the epidemic process and epidemic risks of COVID-19 in the subjects of the Northern Caucasus

Relevance. The peculiarities of the course of the COVID-19 epidemic process in the regions of the world, as a rule, are determined by the epidemic risks characteristic of them. Identification and evaluation of the latter is necessary to improve measures to counter infection in a particular area. Aim. To study the features of the COVID-19 epidemic process in the regions of the North Caucasus, to identify and assess the impact of epidemic risk factors on the epidemic situation. Materials and methods. The data of the Departments of Rospotrebnadzor for the subjects of the North Caucasus, Internet resources: stopkoronavirus were used Russia, Johns Hopkins University and Our World in Data project. Statistical processing was carried out using methods of variation statistics and MS Excel software package (2016, USA). Correlation analysis was performed using Spearman's coefficient. Results. As of 01.12.2021, the incidence of COVID-19 in the Caucasus was lower than the Russian average (3890.0 and 65921.8 per 100 thousand population), and the mortality rate was higher (4.8 and 1.9%, respectively). The dynamics of the epidemic process as a whole repeated the situation in the Russian Federation, but with a delay of each phase by 2–3 weeks and had 4 periods of rising morbidity (waves), with the exception of the Stavropol Territory, the Republics of Adygea and Ingushetia, where three waves of morbidity were observed. In the Republics of Dagestan, Chechen and Adygea, a high proportion of community-acquired pneumonia was noted-58.8, 47.0 and 34.1%, respectively. The mortality rate from a new coronavirus infection was higher than the national average in Dagestan (in the period of the 1st wave – 4.7%), Krasnodar Krai (in the period of the 2nd wave – 5.0%;3 – 12.6%, in 4 – 9.9%), Karachay-Cherkess Republic (in the 3rd period of the rise – 9.0%) and in Stavropol Krai (in 4 – 7.6%). The lowest mortality from COVID-19 in the 3rd and 4th periods of the rise in morbidity in the North Caucasus was registered in Ingushetia – 2.2 and 2.1%, respectively. The exceptional situation in the Republic of Dagestan is due not only to a large proportion of community-acquired pneumonia and high mortality from COVID-19, compared with other regions of the North Caucasus and Russia as a whole, but also to an increase in excess mortality in the republic. The excess of the average annual (over the previous 5 years) number of deaths in the Caucasus in 2020 was +19.8%, in 2021 +32.7%, in the Russian Federation as a whole 14.8 and 31.4%, respectively. Conclusion. The general epidemic risks of COVID-19 for the North Caucasus region have been identified – the level of vaccination, the implementation of non–specific prevention measures, as well as local risks for specific regions: in Dagestan – adherence to local mass ceremonies, as well as insufficient control over the implementation of restrictive measures, in Ingushetia – relatively high population density. © 2023, Numikom. All rights reserved.

Tuberculosis related lethality structure in Kharkiv, Ukraine: impact of COVID 19

Ukraine is one of the leading countries with the highest tuberculosis (TB) burden in the world, and in 2020 we had met with the decrease of TB incidence rates (42,2 compare to 53,7 per 100000 population in 2019). We aimed to analyze the impact of COVID 19 on the structure of the TB lethality. Materials and methods. We compare the following indicators: 1) number of deaths and TB-inpatient lethality, 2) number of days spent in the hospital before the lethal outcome, 3) HIV-TB co-infection among the given cases. All the indicators were for 2019, 2020 and 2021 of TB dispensaries which collect TB-related data from the whole 2,5 million city Kharkiv, Ukraine. Result(s): During 2019 there were hospitalized and treated 942 TB patients, 70 were died (7,4 %), and among them 18 (25,7 %) - HIV-TB co-infected, in 2020 hospitalizations were decreased - 708, with 47 (6,6 %) lethality and 13 (27,7 %) HIV-TB co-infected deaths. In 2021, than the quarantine restrictions almost lifted, the number of hospitalizations decreased again - 588 patients were treated in TB hospitals, lethality extremely increased - 68 (11,7 %) with 27 (39,7 %) HIV-TB co-infection deaths. The survival curve analysis, made by life expectancy in days or weeks after hospitalization, are approximately the same in 2019 and 2020, but are quite different in 2021 - among the lethal outcomes, there is a slightly higher proportion of patients who died after at least 30 days of the treatment (17 % in 2019 versus 25 % in 2021). Thus, increasing lethality and proportion of TB-HIV coinfection together with the decrease in the number of treated patients may indicate on hidden process of TB increased incidence. Active TB case-finding is urgently needed in Ukraine.

Experience of the Clinical Infectious Diseases Hospital named after S.P. Botkin in the pandemic of a new coronavirus infection.

The article presents the results of a two-year work of the Clinical Infectious Diseases Hospital named after S.P. Botkin (Botkin Hospital) during the pandemic of a new coronavirus infection from March 01, 2020 to March 01, 2022. The characteristics of patients with a new coronavirus infection by age, severity of the disease, need for intensive care, including mechanical ventilation and ECMO, are given. Estimated hospital mortality from a new coronavirus infection. The contribution of concomitant infectious diseases (HIV infection, chronic viral hepatitis) to the lethality of patients with COVID-19 is presented. The volumes of assistance to pregnant women, women in childbirth and puerperas with COVID-19, as well as patients on program hemodialysis are presented. The structure of hospitalized patients according to nosological forms was analyzed. Against the backdrop of a massive influx of patients with COVID-19, a sharp decrease in hospitalization of patients with other infectious diseases was noted.Copyright © 2022 Authors. All rights reserved.

Practice note: Domestic violence advocacy and response to intimate partner homicide in the COVID-19 era

The global pandemic has changed how frontline service providers respond to domestic violence (DV). Advocates see an increase in the severity and complexity of DV cases, with COVID-19 complicating decisions of DV survivors to seek help. Domestic Violence High Risk Teams (DVHRT) include police, probation and parole officers, prosecutors, medical professionals, and DV advocates uniquely poised to respond collaboratively to increased DV case numbers and escalating risk of lethality for DV survivors. Adapting intervention and advocacy to the online sphere carries challenges but also opportunities to help DV survivors and their communities find safety. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Initial Management of COVID-19 Outbreak in Mexico

This paper analyzes the initial stage of the pandemic COVID-19 in Mexico. The objective is to test whether the contagion risk perception and the authorities' initial prevention messages influenced the COVID-19 deaths. We estimate longitudinal elasticities of deaths to confirmed COVID-19 cases by accounting for measurement error and endogeneity issues. We find that confirmed cases and poverty levels are endogenous. The limitation arises because of the underreported COVID-19 deaths. Our contribution is to identify an association with the individual and political risk perception to the number of COVID-19 deaths. The results show that municipalities with more confirmed cases aware of being in contact with another person affected by COVID-19 have fewer deaths. However, emergency management, federal and state, had weak effects of reducing the lethality rate. We infer that better individual risk awareness is an essential factor in reducing the number of deaths from COVID-19. JEL Classification: C23, H12, H75, I10, O54. © 2021 The Author(s).

Epidemiology and survival of lung cancer patients, the impact of COVID-19. (clinical and population-based study).

Aim. The study is aimed at investigating the incidence of lung cancer (LC) at the population level with the analysis of key analytical indicators in the context of coronavirus. Materials and methods. We have used data from the IARC, statistical reference books of P.A. Herzen Moscow Research Oncological Institute, data from N.N. Petrov NMRC of Oncology, and the database of the Population Cancer Registry of St. Petersburg (DB PCR St. Petersburg) for the current study. Results. The study has established a steady decline in the incidence of LC among the male population in the worldwide, in Russia and in St. Petersburg. Among the female population, a significant increase in the incidence has been revealed. On the basis of the database PCR St. Petersburg, the patterns of age-sex indicators of the incidence of LC have been analyzed. It has been established that the largest number of cases is registered in the age group of patients over 70 years old, here the largest losses due to coronavirus have also been identified. An increase in the proportion of early stages of the disease has been noted. The accounting reliability index decreased from 2000 to 2019, with the exception of 2017. Comparison of yearly lethality in the DB PCR St. Petersburg showed a significant difference in the data. The detailed localization structure of LC has been studied, where it has been found out that the first place is occupied by cancer of the upper lobe, bronchi or lung, although over 19 years of observation, a decrease in the proportion of this localization in the total volume of C34 has been noted. The proportion of patients with LC without histological verification has decreased. The influence of the smoking factor on the increased risk of LC has been studied.Copyright © 2022 Izdatel'stvo Meditsina. All rights reserved.

PATHOMORPHOLOGICAL FEATURES OF ACUTE RESPIRATORY DISTRESS SYNDROME IN COMPETING LUNG DISEASES: COVID-19 AND SARCOIDOSIS

The COVID-19 pandemic is a worldwide problem. The clinical spectrum of SARS-CoV-2 infection varies from asymptomatic or paucity-symptomatic forms to conditions such as pneumonia, acute respiratory distress syndrome and multiple organ failure. Objective was to describe a clinical case of SARS-CoV-2 infection in the patient with sarcoidosis and cardiovascular pathology developing acute respiratory syndrome and lung edema. Material and methods. There were analyzed accompanying medical documentation (outpatient chart, medical history), clinical and morphological histology data (description of macro- and micro-preparations) using hematoxylin and eosin staining. Results. Lung histological examination revealed signs of diffuse alveolar damage such as hyaline membranes lining and following the contours of the alveolar walls. Areas of necrosis and desquamation of the alveolar epithelium in the form of scattered cells or layers, areas of hemorrhages and hemosiderophages are detected in the alveolar walls. In the lumen of the alveoli, a sloughed epithelium with a hemorrhagic component, few multinucleated cells, macrophages, protein masses, and accumulated edematous fluid were determined. Pulmonary vessels are moderately full-blooded, surrounded by perivascular infiltrates. Signs of lung sarcoidosis were revealed. Histological examination found epithelioid cell granulomas consisting of mononuclear phagocytes and lymphocytes, without signs of necrosis. Granulomas with a proliferative component and hemorrhage sites were determined. Giant cells with cytoplasmic inclusions were detected — asteroid corpuscles and Schauman corpuscles. Non-caseous granulomas consisting of clusters of epithelioid histiocytes and giant Langhans cells surrounded by lymphocytes were detected in the lymph nodes of the lung roots. Hamazaki–Wesenberg corpuscles inside giant cells were found in the zones of peripheral sinuses of lymph nodes. In the lumen of the bronchi, there was found fully exfoliated epithelium, mucus. Granulomas are mainly observed subendothelially on the mucous membrane, without caseous necrosis. Histological examination of the cardiovascular system revealed fragmentation of some cardiomyocytes, cardiomyocyte focal hypertrophy along with moderate interstitial edema, erythrocyte sludge. Zones of small focal sclerosis were determined. The vessels of the microcirculatory bed are anemic, with hypertrophy of the walls in small arteries and arterioles. Virological examination of the sectional material in the lungs revealed SARS-CoV-2 RNA. Conclusion. Based on the data of medical documentation and the results of a post-mortem examination, it follows that the cause of death of the patient R.A., 50 years old, was a new coronavirus infection COVID-19 that resulted in bilateral total viral pneumonia. Сo-morbidity with competing diseases such as lung sarcoidosis and cardiovascular diseases aggravated the disease course, led to the development of early ARDS and affected the lethal outcome. © 2022 Saint Petersburg Pasteur Institute. All rights reserved.