Elena S. Romanova’s research while affiliated with North-Western State Medical University named after I.I. Mechnikov and other places

In the article, on the example of a clinical case, a variant of the course of severe acute autoimmune hepatitis type II in a 20-year-old woman is analyzed. The prevalence of this disease are presented. Possible types of autoimmune hepatitis course are discussed. The main diagnostic criteria that indicate the likelihood of autoimmune hepatitis and the tactics of managing these patients are described. This clinical case demonstrates that in the absence of epidemiological, anamnestic data indicating a possible viral or toxic liver damage, it is necessary to think and exclude autoimmune liver damage. It is believed that the level of gamma globulin exceeding more than 1.5 times the upper limit of normal and the absence of viral hepatitis are independent predictors of the presence of autoimmune hepatitis, and the earlier immunosuppressive therapy is started, the more favorable the prognosis of the disease.

The legal framework for the provision of medical care, its evaluation and control of quality in Russia requires the attending physician to strictly comply with the provisions of regulatory documents. At the same time, clinical practice shows that the recommended algorithms for the provision of care do not allow in all situations to provide medical care of adequate quality. Analysis of the clinical example shows that in the era of the COVID-19 pandemic, in addition to compliance with the established rules, a thorough assessment of a specific clinical situation in the dynamics of development is necessary and timely correction of treatment and diagnostic measures, including those in excess of the established requirements, are required. The methods of remote monitoring of the patients condition need to be improved, since in their current form they do not provide an objective assessment of the patients condition. Face-to-face examinations of patients with COVID-19 receiving medical care at home should be carried out at least every 72 hours, regardless of the result of the remote assessment. The absence of the effect of therapy within three days may be an indication for transferring the patient to a higher level of medical care.

Background Myocardial involvement in COVID-19 has been described as either coronary artery related ischemic lesions, lymphocyte myocarditis or microangiopathy. Assessment of the link between COVID-19 and the cause of death has been hampered by the limited number of autopsies performed during the pandemics and risk factors associated with the type and extent of myocardial damage remain poorly described. In Russia, the mandatory autopsy approach has been advocated for the cases of suspected COVID-19 related deaths. Purpose To describe the prevalence, extent and risk factors associated with myocardial damage in an unselected cohort of patients deceased with COVID-19. Methods Consecutive patients with PCR-confirmed or suspected COVID-19 who died either in-hospital (clinical autopsy) or out-of-hospital (forensic autopsy) during COVID-19 pandemic underwent post-mortem PCR on pulmonary parenchymal tissue. Tissue PCR-positive cases were referred for histology study of pulmonary and extrapulmonary organ specimens through a central laboratory. Based on the extent of diffuse alveolar damage (DAD), COVID-19 was categorized as either being related to death or a concomitant condition not associated with death. Myocardial involvement was categorized as either (1) coronary artery related myocardial infarction, (2) microangiopathy with interstitial edema and erythrocyte aggregates occluding the capillaries with or without lymphomononuclear infiltration and (3) lymphocyte myocarditis. The presence of myocardial involvement was assessed with regard to age, gender and autopsy-verified significant coronary artery disease (CAD) and diabetes (information available only for the clinical autopsy cohort). Results 102 autopsies were included, of whom 42 were clinical and 60 forensic (age 73±15 years, 50% men; 58% had CAD). Ten patients from the clinical autopsy cohort had diabetes (24%). Deaths were COVID-19 related in 80 patients (78%). Myocardial infarction was noted in 3 (2.9%) patients. Microangiopathy was seen in 45 (44%) and lymphocyte myocarditis in 2 (1.9%) patients, of whom it was the primary cause of death in one. The prevalence of microangiopathy did not differ between patients with and without significant DAD (46% vs 45%, p=0.848). Patients with diabetes were more likely to have microangiopathy with lymphomononuclear infiltration in the myocardium than patients without diabetes (40% vs 3.1%, p=0.008; OR=22, 95% CI 1.63–305, p=0.020 after adjustment for age, gender and CAD) Conclusion Systematically performed autopsies revealed causative association between SARS-CoV2 and death in the vast majority. Myocardial involvement was observed in nearly half of the patients and was not related to the extent of DAD. Myocarditis appears to be a rare finding, though it can be the primary cause of death. Microangiopathy with capillary occlusion and lymphomononuclear infiltration in the myocardium was associated with the history of diabetes. Funding Acknowledgement Type of funding sources: None.

Importance Assessment of the causative association between the COVID‐19 and cause of death has been hampered by limited availability of systematically performed autopsies. We aimed to present autopsy‐confirmed causes of death in patients who died with COVID‐19 and to assess the association between thrombosis and diffuse alveolar damage consistent with COVID‐19 (DAD). Methods Consecutive forensic (n=60) and clinical (n=42) autopsies with positive postmortem SARS‐CoV2 PCR in lungs (age 73±14 years, 50% men) were included. Cause of death analysis was based on a review of medical records and histology reports. Thrombotic phenomena in lungs were defined as pulmonary thromboembolism (PE), thrombosis in pulmonary artery branches or microangiopathy in capillary vessels. Results COVID‐19 caused or contributed to death in 71% of clinical and 83% of forensic autopsies, in whom significant DAD was observed. Of the patients with COVID‐19 as the primary cause of death, only 19% had no thrombotic phenomena in the lungs, as opposed to 38% among those with COVID‐19 as a contributing cause of death and 54% among patients whose death was not related to COVID‐19 (p=0.002). PE was observed in 5 patients. Two patients fulfilled the criteria for lymphocyte myocarditis. Conclusions Vast majority of all PCR‐positive fatalities, including out‐of‐hospital deaths, during SARS‐CoV2 pandemic were related to DAD caused by COVID‐19. Pulmonary artery thrombosis and microangiopathy in pulmonary tissue were common and associated with the presence of DAD, while venous PE was rarely observed. Histology‐confirmed lymphocyte myocarditis was a rare finding. Abstract

The article is devoted to the peculiarities of the clinical course of severe coronavirus infection in a 59-year-old woman at risk for comorbidities. Data on the pathogenesis of the severe form of COVID-19 are presented. Prognostic laboratory signs of an unfavorable outcome of coronavirus infection in people at risk are considered. The patient management tactics are described in accordance with the protocol for the treatment of new coronavirus infection. The assessment of patient management at the outpatient stage is given. A new coronavirus infection in at-risk patients can quickly lead to a worsening of the condition, which is manifested by severe lung damage not only according to computed tomography data, but also by the clinical symptom of ARDS. The severity of the condition in this category of patients is due to severe viral aggression, the development of a cytokine storm. The use of the recommended protocol for the treatment of new coronavirus infection in patients at risk does not always give the expected positive result.

The lecture is devoted to non-specific prevention of coronavirus infection. Various measures are described to prevent the spread of COVID-19 to both the public and healthcare providers. The characteristic of various measures for the disinfection of medical and household waste is given. A detailed description of various personal protection methods with a description of the rules for their use is given. Attention is drawn to the rules for the use of personal protective equipment during a pandemic. Attention is drawn to common errors encountered when using personal protective equipment. The importance of their use in order to prevent the spread of infection outside medical institutions is emphasized.

The lecture sets out modern ideas about the etiology of viral hepatitis E, considering its species, physical and chemical properties. The questions of epidemiology are covered, namely, a characteristic of the zones of the spread of the virus, transmission routes, depending on the genotype of the virus, is given. Issues of the pathogenesis of the disease are also given taking into account new data on the virus genotypes. The acute and chronic forms of the course of the disease and extrahepatic manifestations of this infection are described. Their clinical picture, laboratory diagnostic methods, modern principles of therapy and prevention are given.