Coronavirus Disease 2019 (COVID-19), caused by SARS-CoV-2, has negatively affected global health. COVID-19 has been associated with a variety of autoimmune and inflammatory disorders, complicating its respiratory manifestations. SARS-CoV-2 triggers inflammatory reactions which may involve multiple organs and systems. The proof for IgA involvement in the immune reactions to coronavirus infection is growing, particularly in the case of IgA immune complex deposition diseases such as IgA vasculitis (IgAV) and IgA nephropathy.This report presents a case of IgAV caused by SARS-CoV-2 in a 53-year-old man. His symptoms included papillomatous, bright red rashes, urticaria throughout the body, aphthous stomatitis, pain in all joints and muscles, weakness, malaise, abdominal pain, face swelling, and arterial hypertension (160/100 mmHg). He received intravenous methylprednisolone (250 mg) and then oral methylprednisolone (16 mg) treatment, which improved his condition. This improvement included the disappearance of abdominal and joint pain and skin rashes.This article also provides an overview of published cases of IgAV after SARS-CoV-2. It may alert rheumatologists and allied specialists of clinical features of IgAV and guide them how to diagnose and treat this disease.

BACKGROUND: Post-coronavirus disease 2019 (COVID-19) symptoms were widely reported. However, data on post-COVID-19 conditions following infection with the Omicron variant remained scarce. This prospective study was conducted to understand the prevalence, patterns, and duration of symptoms in patients who had recovered from COVID-19.
METHODS: A prospective study was conducted across 11 districts of Delhi, India, among individuals who had recovered from COVID-19. Study participants were enrolled, and then returned for post-recovery follow-up at 3 months and 6 months interval.
RESULTS: The mean age of study participants was 42.07 years, with a standard deviation of 14.89 years. The majority of the participants (79.7%) reported experiencing post-COVID-19 symptoms. The most common symptoms included joint pain (36.0%), persistent dry cough (35.7%), anxiety (28.4%), and shortness of breath (27.1%). Other symptoms were persistent fatigue (21.6%), persistent headache (20.0%), forgetfulness (19.7%), and limb weakness (18.6%). The longest duration of symptom was observed to be anxiety (138.75±54.14 days), followed by fatigue (137.57±48.33 days), shortness of breath (131.89±60.21 days), and joint pain/swelling (131.59±58.76 days). At the first follow-up visit, 2.2% of participants presented with abnormal electrocardiogram readings, but no abnormalities were noticed during the second follow-up. Additionally, 4.06% of participants exhibited abnormal chest X-ray findings at the first followup, which decreased to 2.16% by the second visit.
CONCLUSIONS: The most frequently reported post-COVID-19 symptoms were joint pain, dry cough, anxiety and shortness of breath. These clinical symptoms persisted for up to 6 months, with evidence of multi-system involvement. Consequently, findings highlighted the need for long-term follow-up during the post-COVID-19 period.

OBJECTIVE: To demonstrate clinical features and outcomes in patients with cavitary lung lesions and COVID-19 associated pneumonia.
METHODS: A retrospective analysis of electronic medical records of 8261 patients with COVID-19 was performed. We selected 40 patients meeting the inclusion criteria. Sex, age, hospital-stay, lung tissue lesion, comorbidities, treatment, methods of respiratory support, complications and outcomes were evaluated.
RESULTS: Cavitary lung lesions were more common in men (67.5%). Age of patients ranged from 28 to 88 (mean 64.9±13.7) years. Hospital-stay in patients with cavitary lung lesions was 9-58 (median 27.5) days. There were 18 complications in 14 (35%) patients. Pneumothorax, isolated pneumomediastinum, pleural empyema, hemoptysis and sigmoid colon perforation were considered as complications of cavitary lung lesions. Nine (22.5%) patients died (5 of them with complications). Three patients died after surgical treatment. Long-term results were analyzed in 8 (25.8%) patients. Patients were followed-up for 3 months after discharge. Shrinkage of lesions occurred after 7-60 (mean 23) days, and complete obliteration of cavities came after 32 (range 14-90) days.
CONCLUSIONS: Cavitary lung lesions are a rare complication of COVID-19 pneumonia. There was no significant correlation of complications with age, sex, therapy, volume of lung lesions and non-invasive ventilation (NIV). Despite more common fatal outcomes in older patients undergoing NIV, the last one was prescribed exclusively due to disease progression and respiratory failure. Further research on this problem is necessary to identify possible risk factors of cavitary lung lesions.
UNASSIGNED: Демонстрация клинических особенностей и исходов лечения пациентов с полостными образованиями легких при COVID-19-пневмонии.
UNASSIGNED: Проведен ретроспективный анализ электронных медицинских карт 8261 пациента с подтвержденным диагнозом COVID-19. Всего были отобраны 40 пациентов, отвечающих критериям включения. Оценивали пол, возраст, длительность госпитализации, объем поражения легочной ткани по данным высокоразрешающей компьютерной томографии органов груди (ВРКТ), сопутствующие заболевания, лечение, методы респираторной поддержки, осложнения и исходы госпитализации.
UNASSIGNED: Чаще всего полостные образования (ПО) легких обнаруживали у мужчин (67,5%), их возраст варьировал от 28 до 88 лет (средний возраст 64,9±13,7 года). Пациенты с ПО находились в стационаре от 9 до 58 дней, медиана продолжительности госпитализации составила 27,5 (23) сут. У 14 (35%) пациентов с ПО всего было выявлено 18 осложнений. В качестве осложнений ПО рассматривались пневмоторакс, изолированный пневмомедиастинум, эмпиема плевры, кровохарканье, перфорация сигмовидной кишки. Умерли 9 (22,5%) пациентов (5 из них с осложнениями). Среди пациентов, получивших оперативное лечение, умерли трое. Отдаленные результаты удалось проследить у 8 (25,8%) пациентов. Пациенты находились под наблюдением в течение 3 мес после выписки. Сроки появления положительной динамики в виде уменьшения полостей на ВРКТ варьировали от 7 до 60 дней (в среднем 23 дня), а полная облитерация полостей среди обсервационных пациентов наступала в среднем на 32-е сутки (от 14 до 90 дней).
UNASSIGNED: ПО являются редким осложнением течения COVID-19-пневмонии. При этом у пациентов с ПО статистически значимой зависимости развития осложнений от возраста, пола, получаемой терапии, объема поражения легких на ВРКТ, проведения неинвазивной вентиляции легких (НВЛ) выявлено не было. Несмотря на то что летальный исход чаще наступал у пациентов более старшего возраста и на фоне проведения НВЛ, ее назначение связано исключительно с прогрессированием заболевания и нарастанием дыхательной недостаточности, а не как вариант лечения пациентов с ПО. Дальнейшие исследования по данной проблеме необходимы для выявления возможных факторов риска появления ПО, в том числе НВЛ.

Since the beginning of the COVID-19 pandemic, vitamin D has attracted interest due to its immunomodulatory properties. Numerous studies show a correlation between vitamin D levels and COVID-19 cases and mortality. Therefore, we conducted a meta-analysis in order to assess the relationship between vitamin D3 supplementation and COVID-19 severity. We included 13 randomized clinical trials that contained the analyzed endpoints: length of COVID-19 hospitalization, number of intensive care unit (ICU) admissions, length of stay in the ICU, number of cases requiring any supplemental oxygenation, duration of any supplemental oxygenation, number of overall mortality and number of deaths associated with COVID-19. The relative risk with 95% confidence interval (CI) and the mean difference with 95% CI were calculated to compare the effect. A random effects model was used to calculate effect sizes. Our meta-analysis showed a positive effect of vitamin D3 supplementation on ICU admission (RR = 0.73; 95% CI [0.57; 0.95], p = 0.02, I2 = 19.6%) and mortality associated with COVID-19 among patients (RR = 0.56; 95% CI [0.34; 0.91]; p = 0.02; I2 = 0%). Vitamin D3 supplementation may potentially reduce the risk of ICU admission and death associated with COVID-19.

OBJECTIVE: To identify the risk factors of pulmonary cavitation in COVID-19 pneumonia.
METHODS: A retrospective study included 8261 patients with COVID-19 between April 2020 and March 2022. Inclusion criteria: age >18 years, COVID-19 confirmed by polymerase chain reaction. Two cohorts of patients were formed: 40 patients with pulmonary cavitation and 40 patients without these lesions. Both groups were comparable in age, lung lesion volume and oxygenation. Sex, age, length of hospital-stay, CT grade of lung lesion, comorbidities, treatment, respiratory support, oxygen saturation and in-hospital outcomes were evaluated. The highest lung lesion volume during hospitalization was assessed. CT was performed upon admission and approximately every 5 days for evaluation of treatment. Statistical analysis was performed using the IBM SPSS Statistics software (IBM Corporation, USA).
RESULTS: Patients with pulmonary cavitation significantly differed in age, SpO2, lung lesion volume, more common non-invasive ventilation and prolonged hospital-stay. Cardiovascular diseases were more common in both groups. Univariate logistic regression analysis revealed age, cardiovascular diseases, CT-based severity of lung damage, absence of biological therapy and non-invasive ventilation as risk factors of pulmonary cavitation. According to multivariate logistic regression analysis, these predictors were CT-based severity of lung damage and absence of biological therapy. Univariate logistic regression analysis showed that pulmonary cavitation had no significant effect on mortality (OR=2.613, 95% CI: 0.732-9.322, p=0.139).
CONCLUSIONS: The risk of pulmonary cavitation in COVID-19 is directly related to advanced lung damage and untimely or absent biological therapy with IL-6 inhibitors. Pulmonary cavitation in COVID-19 is not a typical manifestation of disease and can be caused by some factors: fungal infection, secondary bacterial infection, tuberculosis and pulmonary infarction. Further study of this problem is required to develop diagnostic algorithms and treatment tactics.
UNASSIGNED: Определить факторы риска появления полостных образований легких при COVID-19.
UNASSIGNED: Проведено ретроспективное исследование электронных медицинских карт 8261 пациента, которые прошли лечение по поводу COVID-19 в Университетской Клинической Больнице №4 Сеченовского Университета в период с апреля 2020 по март 2022 г. Критериями включения были возраст старше 18 лет и диагноз COVID-19, подтвержденный методом полимеразной цепной реакции (ПЦР) в образце биоматериала из ротоглотки и носоглотки. Были сформированы 2 когорты пациентов: 40 пациентов с полостными образованиями (ПО) легких и 40 пациентов без ПО легких. Пациенты обеих групп были сопоставимы по возрасту, объему поражения легких и оксигенации. Оценивались пол, возраст, длительность госпитализации, объем поражения легочной ткани по данным высокоразрешающей компьютерной томографии органов груди (ВРКТ), сопутствующие заболевания, лечение, методы респираторной поддержки, самый высокий и самый низкий показатели сатурации кислорода (SpO2) при дыхании атмосферным воздухом и исходы госпитализации. По ВРКТ оценивался наибольший объем поражения легких в ходе госпитализации. ВРКТ выполнялась в приемном отделении при госпитализации и, приблизительно, каждые 5 сут для динамической оценки проводимого лечения. Статистическая обработка данных осуществлялась с использованием программного обеспечения SPSS Statistics 26 (StatSoft Inc., США).
UNASSIGNED: Больные с ПО статистически значимо отличались по возрасту, SpO2, объему поражения легочной ткани, более частому назначению неинвазивной вентиляции легких (НВЛ), а также длительности госпитализации. В обеих группах чаще встречались заболевания сердечно-сосудистой системы. При однофакторном логистическом регрессионном анализе возраст, наличие сердечно-сосудистого заболевания, выраженность КТ-изменений паренхимы легких, отсутствие биологической терапии, респираторная поддержка в виде НВЛ были ассоциированы с увеличением риска формирования ПО. При многомерном логистическом регрессионном анализе выявлено, что выраженность КТ-изменений паренхимы легких и отсутствие биологической терапии являются независимыми предикторами формирования ПО. Одномерный логистический регрессионный анализ продемонстрировал, что наличие ПО статистически значимо не влияло на летальность (отношение шансов 2,613; 95% доверительный интервал 0,732—9,322; p=0,139).
UNASSIGNED: Риск развития ПО в легких при COVID-19 напрямую связан с бóльшим объемом поражения легких и несвоевременно проведенной или не проведенной вовсе биологической терапией ингибиторами ИЛ-6. Кавитации в легких при COVID-19 не являются типичным для заболевания проявлением и могут быть вызваны рядом причин: грибковой инфекцией, вторичной бактериальной инфекцией, туберкулезом, инфарктом легкого. Требуется дальнейшее изучение данной проблемы для разработки диагностических алгоритмов и определения тактики лечения.

UNASSIGNED: During the Coronavirus disease (COVID-19) pandemic, clinicians recommended awake-prone positioning (APP) to avoid the worst outcomes. The objectives of this study were to investigate if APP reduces intubation, death rates, and hospital length of stay (HLOS) in acute COVID-19.
UNASSIGNED: We performed a retrospective cohort with non-mechanically ventilated patients hospitalized in a reference center in Manaus, Brazil, 2020. Participants were stratified into APP and awake-not-prone positioning (ANPP) groups. Also, we conducted a systematic review and performed a meta-analysis to understand if this intervention had different outcomes in resource-limited settings (PROSPERO CRD42023422452).
UNASSIGNED: A total of 115 participants were allocated into the groups. There was no statistical difference between both groups regarding time to intubation (HR: 0.861; 95CI: 0.474-1.1562; p=0.622) and time to death (HR: 1.666; 95CI: 0.939-2.951; p=0.081). APP was not significantly associated with reduced HLOS. A total of 86 articles were included in the systematic review, of which 76 (88,3%) show similar findings after APP. Also, low/middle, and high-income countries were similar regarding such outcomes.
UNASSIGNED: APP in COVID-19 does not present clinical improvement that affects mortality, intubation rate and HLOS. The lack of a prone position protocol, obtained through a controlled study, is necessary. After 3 years, APP benefits are still inconclusive.

Atrial fibrillation (AF) is the most common heart rhythm disorder in clinical practice. It worsens the quality of life of patients, leads to an increase in the mortality rate because of its association with a high risk of thromboembolic complications. The current pandemic of a new coronavirus infection, which began in March 2020, was marked by an increase in cardiovascular diseases, including an increase in the number of patients with AF. That is why it is extremely relevant to find answers to questions about the association and mutual influence of AF and coronavirus infection to reduce the risk of vascular complications. However, most research in this area has focused on hospital patients. In this study, an electronic database of outpatients with AF, including patients with a history of COVID-19 infection was analyzed in order to assess the most significant risk factors for complications.

BACKGROUND: During the early coronavirus disease (COVID-19) pandemic in 2020, researchers cautioned about the potential neuroinvasive capability of the virus and long-term neurological consequences. Although a few preliminary studies have found delayed communication, fine motor, and problem-solving skills in infants after COVID-19 infection, there continues to be a paucity of data on long-term development of neonates diagnosed with COVID-19.
METHODS: We conducted a prospective study of 20 neonates who acquired severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection during the first wave of the pandemic (April-July 2020). At 18-24 months corrected age, we assessed neurodevelopment by Bayley Scales of Infant and Toddler Development, the third edition (BSID-III), along with growth, hearing, and vision evaluation.
RESULTS: The mean corrected age at assessment was 21 months 11 days ± 1 month 28 days. We found developmental delay in nearly half of the children with scores below one standard deviation in either of the BSID-III domains. Mild delay in either motor, cognitive, or language domains was found in 9 (45%) children and moderate delay in 2 (10%). Expressive language, fine motor, and receptive language were predominantly affected. None of the children had hearing impairment, blindness, or significant growth faltering including clinically severe microcephaly. The mean composite cognitive, language, and motor scores were significantly lower in those with neurodevelopmental delay (p value - 0.02, 0.000, and 0.03, respectively) without any differences in their disease characteristics.
CONCLUSIONS: Neonates infected with SARS-CoV-2 have an increased risk of developmental delays in expressive language, fine motor, and receptive language skills at 18-24 months of age. The severity of delays is predominantly mild.

We measured the levels of bacterial endotoxins in the bulk vaccine product (BVP) and finished vaccine QazCovid-in® and evaluated the effect of aluminum hydroxide (adjuvant) on the results of LAL test and pyrogenicity of samples in vivo (in rabbits receiving intravenous injection into the marginal ear vein). Administration of BVP with LPS resulted in a dose-dependent increase in body temperature in rabbits similar to that caused by LPS alone, which suggests that aluminum hydroxide in the vaccine did not affect the pyrogenic response in rabbits. Moreover, the LAL test showed that the aluminum hydroxide did not hinder LPS activity after serial dilution of samples.

To compare a private quaternary referral hospital, a public tertiary hospital, and a field hospital dedicated to patients with COVID-19, regarding patients\' characteristics, clinical parameters, laboratory, imaging findings, and outcomes of patients with confirmed diagnosis of COVID-19.
Retrospective multicenter observational study that assessed the association of clinical, laboratory and CT data of 453 patients with COVID-19, and also their outcomes (hospital discharge or admission, intensive care unit admission, need for mechanical ventilation, and mortality caused by COVID-19).
The mean age of patients was 55 years (±16 years), 58.1% of them were male, and 41.9% were female. Considering stratification by the hospital of care, significant differences were observed in the dyspnea, fever, cough, hypertension, diabetes mellitus parameters, and CT score (p < 0.05). Significant differences were observed in ward admission rates, with a lower rate in the private hospital (40.0%), followed by the public hospital (74.1%), and a higher rate in the field hospital (89.4%). Regarding intensive care unit admission, there was a higher rate in the public hospital (25.2%), followed by the private hospital (15.5%), and a lower rate in the field hospital (9.9%). In the analysis of the discharge and death outcomes, it was found that there was a higher number of patients discharged from the private hospital (94.2%), compared to the field hospital (90.1%) and public hospital (82.3%) and a higher number of deaths in the public hospital (17.7%) compared to the private hospital and field hospital (5.8 and 0% respectively).
The analysis of the data regarding the population treated with COVID-19 during the first wave in different levels of care in the public and private health systems in the city of São Paulo revealed statistically significant differences between the populations, reflecting distinct outcomes.