Remodeling of T Cell Dynamics During Long COVID Is Dependent on Severity of SARS-CoV-2 Infection.

Several COVID-19 convalescents suffer from the post-acute COVID-syndrome (PACS)/long COVID, with symptoms that include fatigue, dyspnea, pulmonary fibrosis, cognitive dysfunctions or even stroke. Given the scale of the worldwide infections, the long-term recovery and the integrative health-care in the nearest future, it is critical to understand the cellular and molecular mechanisms as well as possible predictors of the longitudinal post-COVID-19 responses in convalescent individuals. The immune system and T cell alterations are proposed as drivers of post-acute COVID syndrome. However, despite the number of studies on COVID-19, many of them addressed only the severe convalescents or the short-term responses. Here, we performed longitudinal studies of mild, moderate and severe COVID-19-convalescent patients, at two time points (3 and 6 months from the infection), to assess the dynamics of T cells immune landscape, integrated with patients-reported symptoms. We show that alterations among T cell subsets exhibit different, severity- and time-dependent dynamics, that in severe convalescents result in a polarization towards an exhausted/senescent state of CD4+ and CD8+ T cells and perturbances in CD4+ Tregs. In particular, CD8+ T cells exhibit a high proportion of CD57+ terminal effector cells, together with significant decrease of naïve cell population, augmented granzyme B and IFN-γ production and unresolved inflammation 6 months after infection. Mild convalescents showed increased naïve, and decreased central memory and effector memory CD4+ Treg subsets. Patients from all severity groups can be predisposed to the long COVID symptoms, and fatigue and cognitive dysfunctions are not necessarily related to exhausted/senescent state and T cell dysfunctions, as well as unresolved inflammation that was found only in severe convalescents. In conclusion, the post-COVID-19 functional remodeling of T cells could be seen as a two-step process, leading to distinct convalescent immune states at 6 months after infection. Our data imply that attenuation of the functional polarization together with blocking granzyme B and IFN-γ in CD8+ cells might influence post-COVID alterations in severe convalescents. However, either the search for long COVID predictors or any treatment to prevent PACS and further complications is mandatory in all patients with SARS-CoV-2 infection, and not only in those suffering from severe COVID-19.

Current knowledge on the use of ultrasound measurements of fetal soft tissues for the assessment of pregnancy development.

Ultrasonography, with its detailed imaging of the fetus, is very widely used in obstetrics. The primary aim of ultrasound scanning in pregnancy is to limit the risk of obstetric complications by early detection of abnormalities, such as intrauterine growth restriction and macrosomia. Currently, morphometric formulae are used for estimating fetal weight. They utilize basic biometric parameters. However, Hadlock formula, used for fetal weight estimation, has an error rate of 20%. For this reason, researchers all over the world have been looking for other sonographic parameters correlating with fetal weight, with a higher predictive value. The current scientific reports indicate that new sonographic parameters, such as soft tissue thickness values, are useful for fetal weight assessment. The measurements can be conducted in various parts of the fetus's body, e.g. thigh, upper arm, abdomen or the subscapular area. Different types of measurements are characterized by different levels of correlation with other sonographic and anthropometric parameters as well as body mass and gestational age. Based on the reports, numerous studies proposing new fetal weight calculation formulae have been produced. Apart from soft tissue, some more advanced and detailed measurements are taken, such as those involving adipose and lean tissue or using three-dimensional ultrasound (3D), for determining fetal weight. Ultrasound measurement of subcutaneous tissue thickness in various parts of the body may prove to be a strong predictor of fetal weight, which is useful for sonographic assessment of pregnancy.

Inflammatory bowel disease and pregnancy.

Inflammatory bowel disease (IBD) comprising Crohn's disease (CD), ulcerative colitis (UC), and IBD-unclassified (IBD-U) may appear at any age. As such, IBD commonly affects young patients in their reproductive age. Rate of voluntary childlessness among women with IBD far exceed that of the general population, as patients with IBD fear not only the effect of pregnancy on the course of inflammatory bowel disease, but also the increased risk of the offspring developing the disease, adverse pregnancy outcomes, the effect IBD treatment may have on the health and development of the infant or the risk of relapse during pregnancy and the influence of lactation on child development and disease course. This article aims at improving pre-conception counseling of patients with inflammatory bowel disease.