Therapy

Studies of the presence of macrophages in various organs and tissues in COVID-19 are fragmented and mainly limited to the study of the lungs. The aim of the study was to determine the presence of macrophage infiltration in various organs and tissues in patients with COVID-19. Material and methods. A complex pathoanatomical study of sectional material obtained after autopsies of 23 deceased patients with the main diagnosis of COVID-19 was carried out. Results. Multiple aberrant aggregations of obese CD68 positive macrophages were found, with lesions predominantly observed in the parenchyma of the lungs and kidneys. Conclusion. CD68-positive macrophages were detected in all organs studied in COVID-19 patients, with different intensity and localization of infiltration, which may indicate a single mechanism of pathogenesis in lesions of various organs in patients with this disease.

Results of various studies demonstrate the importance of CAD as a risk factor for poor outcomes in patients with COVID-19. The aim: to compare the clinical picture, data of laboratory and instrumental studies in COVID-19 patients with CAD and without it. Material and methods. The study included 147 inpatients from a multidisciplinary hospital with identified COVID19. They were divided into main and control groups depending on the presence or absence of coronary artery disease. Results. The average age of examined patients was 60,1 ± 15,2 years, the average duration of hospitalization was 11,0±6,7 days. The average age of patients with CAD (main group) was 67.9±9.6 years, without CAD (control group) 57,7±15,9 years. In CAD group, the incidence of obesity (BMI≥30 kg/m2) was significantly lower (17,8 vs 40,2%), and incidence of DM 2, acute myocardial infarction, atrial fibrillation and CHF was significantly higher than in the group without CAD. Also, in the main group, sinus rhythm was significantly more common (82,4 vs 95,2%) and Q wave pathology (11,8 vs 1,0%), the QT interval was longer (0,38±0,04 vs 0,34±0,08 s.), while the ejection fraction was significantly lower (47,86±12,62 vs 60,78±6,89%). The proportion of patients with COVID-19 admitted to the hospital in a severe condition was 2 times higher in the CAD group, they were more likely to experience catarrhal symptoms (28.6 vs. 19.6%) and leg swelling (11,4 vs 3,6%). In the main group, comparatively with the control group, a lower average heart rate was revealed (79,3±14,5 vs 84,6±14,9 beats/min.). The degree of lung damage according to CT of thoracic organs in the groups was approximately the same. Finally, patients with SpO2 <90% (17,1 vs 8,0%) were more than 2 times more likely to occur in CAD group, lower average blood leukocyte level (5,85±3,40 vs 7,65±4,82 x 109 g/l), higher mean sodium levels (140,56±3,83 vs 138,68±4,34 mmol/l) and PTT (44,28±27,71 vs 35,72±6,45 s.), as well as higher mortality rates (5,7 vs 1,8%) were also fixed there. Conclusion. Patients with COVID-19 in combination with CAD comparatively with patients without CAD were significantly older, more often suffered from hypertension, DM 2, acute myocardial infarction, atrial fibrillation, CHF, more often had pathological Q and QT prolongation on ECG, low ejection fraction, SpO2 <90%, leukopenia, elevated sodium levels, PTT, and urea.

Bronchial asthma (BA) is a global medical and social problem. The incidence of asthma and obesity worldwide is steadily increasing. The aim of the study was to evaluate the clinical, pathophysiological and molecular features of various obesity phenotypes in patients with BA in order to optimize anti-asthma therapy and early diagnosis of cardiovascular complications. Material and methods. 150 asthma patients were examined. They were divided into 3 groups depending on the ratio of the onset time of asthma to obesity: «Obesity + BA» (Group 1), «BA + obesity» (Group 2), «BA without obesity» (BMI 18.5-25 kg/m2, Group 3). The comparison group consisted of 30 relatively healthy volunteers. Following parameters were studied: the degree of obesity and asthma, respiratory function parameters, lipid profile, indicators of insulin metabolism, insulin resistance and levels of adipokines in peripheral blood, level of NO in exhaled air (FeNO), cellular composition of induced sputum, values of left ventricular hypertrophy (LVH), thickness of the intima-media complex of the common carotid artery (CCA TIM). Results and conclusion. In the «Obesity + BA» group, a severe course of the disease was recorded more often (33%), which correlated with a low level of control, impaired bronchial patency, and pulmonary hyperinflation formation. In the «Obesity + BA» group, dyslipidemia, insulin resistance, and adipokines imbalance were more evident. FeNO was comparatively lower in the «Obesity + BA» group. When assessing the cellular composition of induced sputum in the Obesity + BA group, neutrophilic biotype was recorded in 39% of patients, and a small granulocytic BA biotype was recorded in 43%. In the group of patients «Obesity + BA», the highest values of LVH and CCA TIM were recorded. Identification of different phenotypes of BA associated with obesity is necessary due to the need to verify patients with high cardiovascular risks.

According to modern concepts, the processes of gestational diabetes mellitus (GDM) associated with pancreatic β-cell dysfunction, insulin resistance (IR) or a combination of these factors may prevail in the basis of the formation of GSD, forming various subtypes of GDM. Identification of risk factors for the development of various subtypes of GDM in pregnant women may be important for timely verification and selection of therapy. Objective: to establish risk factors for the development of various subtypes of GDM. Materials and methods. 130 pregnant women were examined without a history of carbohydrate metabolism disorders. According to the Matsuda index, the subjects were divided into: group I 45 pregnant women with GSD and β-cell dysfunction, group II 43 pregnant women with GSD and IR, group III 42 pregnant women without GSD (control). The study examined risk factors whose contribution to the development of GSD is already well known, as well as factors that, in our opinion, can influence the development of GSD. Carbohydrate metabolism was evaluated. The data were considered statistically significant at p <0,05. Results. Pregnant women with GDM and IR are characterized by an older age at the onset of pregnancy (p=0,009), signs of acanthosis nigricans (p=0,03), the weight of the first child at birth (p=0,047), a large body weight, rarer intake of folic acid and low physical activity before pregnancy (p <0,001). Patients with GDM and β-cell dysfunction are characterized by a younger age, lack of regular MC before pregnancy (p=0,02), lower body weight and BMI (p <0,001) and more frequent use of folic acid (p=0,048). Both groups of patients were characterized by the absence of pre-gravidar preparation (p=0,03). Conclusion. We have found that in addition to the influence of the patient's age and body weight before pregnancy, low physical activity and lack of pregravidar preparation have an important contribution to the development of various subtypes of GDM.

The increase in the incidence of non-alcoholic fatty liver disease (NAFLD) among people of working age is due to the large influence of environmental factors, while the role of the genetic aspect in the formation and progression of this disease is debatable. The purpose. To study the frequency of occurrence of allele pairs by polymorphic loci of matrix metalloproteinase MMP12 (rs652483) genes and gamma receptor activated by peroxisome proliferator PPARG (rs1801282) and to determine the role of genes in the formation of NAFLD in obese women and compare with practically healthy women in Perm. Material and methods. The study included 100 obese patients who were divided into groups: group 1 (n=50) patients without NAFLD (average age 43,3±5,6 years); group 2 (n=50) patients with established NAFLD (average age 45,3±3,2 years). The control group consisted of 100 healthy women from Perm. Single nucleotide polymorphic variants of genes were determined by the method of allele-specific polymerase chain reaction using sets of genes MMP12 (rs 652483), PPARG (rs1801282). Results. Carrying the Pro12Pro genotype of the PPARG gene increases the risk of obesity by 2 times (x2=5,31, p=0,02, OR 2,05), carrying the Pro12Ala genotype reduced the risk of obesity and NAFLD by 1,7 times (x2=5,89, p=0,04, OR 0,58). Carrying the pPArG genotype Pro12Pro increases the risk of developing NAFLD in obese patients by 2,5 times. Carrying the polymorphism of the Ala12Ala genotype reduced the risk of obesity by 9 times (x2=4,23; p=0,04; OR 0,11). Carriers of the Ala12Ala genotype were associated with an increase in IGF-1 levels (p=0,024), carriers of the Pro12Pro genotype with an increase in TG levels (p=0,018). The associations of the carrier of the polymorphic position of the MMR12 gene with an increase in the waist/hip ratio (p=0,02), cystatin C (p=0,01) and MCP-1 (p=0,004) were obtained. Conclusions. In the female population carrying the PPARG gene polymorphism (rs1801282) of the Ala12Al genotype reduces the risk of obesity and metabolic disorders, carrying the Pro12 Pro genotype increases the risk of obesity and NAFLD. The carrier of the polymorphism of the MMR 12 gene (rs 652438) in women is associated with the development of abdominal obesity and systemic inflammatory response.

Accumulated clinical experience shows that the pathogenesis of respiratory distress syndrome in patients with COVID-19 has a huge range of manifestations. The key component of this pathogenesis is endothelial dysfunction and dysregulation of multiple molecular and cellular control systems for blood coagulation, microhemodynamics, diffusion, hyperinflammation, and immunothrombosis, which is referred to in this review as «storm-2». From the viewpoint of pathophysiology, COVID-19 is a dissonance of a large number of cellular and molecular components, functional details that make up homeostasis, which, under conditions of viral aggression, work as a sequential destruction system. The processes of biochemical and cellular disorganization caused by the SARS-CoV-2 coronavirus reflect the key links in the pathogenesis of a new coronavirus infection. Identification of these links determines the search for effective approaches to the treatment of COVID-19 using both traditional and innovative curative facilities.

Article presents a case of sudden PATE after COVID-19 in a 36-year-old female patient. The patient was admitted to the cardiology department with complaints of mixed dyspnea. She had suffered from COVID-19 about a month earlier and had syncope condition the same month. After admission to the hospital, the patient was diagnosed with bilateral polysegmental interstitial pneumonia, and three days later she was discharged for outpatient treatment. Having suffered episodes of loss of consciousness three times a few days after discharge, she went to the city hospital on her own. On examination, the condition is satisfactory, body temperature is 36,8 °C, SpO2 is 91%, blood pressure is 130/70 mm Hg, pulse is 80/min. Ultrasound of the veins of the lower extremities - no signs of thrombosis. According to MSCT angipulmonography data, two days after the appeal, the patient was diagnosed with thromboembolism of the pulmonary artery and its branches. This observation allows us to conclude that the high incidence of thromboembolism in COVID-19 requires clinical vigilance regarding this complication even among young people and consideration of the appointment of anticoagulants, regardless of the treatment conditions.

Article presents two clinical observations of patients with associated polycystic liver and kidney disease. Their peculiarity is the presence of clinical manifestations of the disease, which, according to the literature data, is rare. Both cases had a family history of polycystic liver and kidney disease. Onset of illness in example No. 1 occurred at 76 years of age, in example No. 2 at 44 years of age. At the same time, a different outcome of the disease was fixed with the development of portal hypertension in the first case and the need for bisegmentotomy in the second. Both patients were included in the waiting list for liver transplantation.

With the support of: Russian Scientific Medical Society of Internal Medicine (RSMSIM), Russian Association of Allergologists and Clinical Immunologists (RAACI), Society of Clinical Pharmacologists of Russia.