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Defining and managing COVID-19-associated pulmonary aspergillosis: the 2020 ECMM/ISHAM consensus criteria for research and clinical guidance
No full textSevere acute respiratory syndrome coronavirus 2 causes direct damage to the airway epithelium, enabling aspergillus invasion. Reports of COVID-19-associated pulmonary aspergillosis have raised concerns about it worsening the disease course of COVID-19 and increasing mortality. Additionally, the first cases of COVID-19-associated pulmonary aspergillosis caused by azole-resistant aspergillus have been reported. This article constitutes a consensus statement on defining and managing COVID-19-associated pulmonary aspergillosis, prepared by experts and endorsed by medical mycology societies. COVID-19-associated pulmonary aspergillosis is proposed to be defined as possible, probable, or proven on the basis of sample validity and thus diagnostic certainty. Recommended first-line therapy is either voriconazole or isavuconazole. If azole resistance is a concern, then liposomal amphotericin B is the drug of choice. Our aim is to provide definitions for clinical research and up-to-date recommendations for clinical management of the diagnosis and treatment of COVID-19-associated pulmonary aspergillosis
Treatment of covid-19 from the perspective of endotheliopathy correction and prevention of thrombotic complications. The agreed position of the experts
No full textThe proposed consensus position of the experts present approaches to the diagnosis, treatment and secondary prevention of throm-botic complications and endothelial dysfunction in COVID-19 for their use in outpatient visits. Experts confirmed the position of LMWH in hospitalized patients. Parnaparin sodium is the optimal choice for these patients, due to strong anti-inflammatory effect and a convenient dosing regimen. Experts confirmed endothelial damage as an important factor in the development of hyper-coagulation in outpatients with COVID-19. According to expert’s consensus position, sulodexide may be a pathogenetic approach for the problem of endothelial dysfunction, especially — for period of convalescence. Experts recommend to introduce of sulo-dexide into the Temporary methodological recommendations of the Ministry of Health of the Russian Federation: for outpatients with light forms COVID-19, for patients with high risk of bleeding, also — for patients at the stage of rehabilitation to prevent recurrent VTE and reduce the risk of developing pulmonary fibrosis
Asymptomatic carrier state as a measure of information uncertainty of the novel coronavirus infection
No full textThis case report describes entropy based on statistics of the novel coronavirus infection in the Russian Federation. Entropy (in bits) determined on the basis of the ratio of patients with clinical manifestations of the disease and asymptomatic carrier state, increased from 0.7219 by April 1, 2020, when the ratio of such patients was 4/5 to 1/5, to 0.8813 by April 14, 2020, when the ratio of the two groups of patients was 7/10 to 3/10. On May 3, 2020, the ratio of the two groups leveled off, reaching ½ to ½, so the entropy was 1.0000. An analysis of the data from April 19, 2020 to June 1, 2020 allowed us to clarify the average proportion between patients with and without symptoms, which is 14/25 to 11/25 with a certain bias towards patients with clinical manifestations of the novel coronavirus infection, and the entropy for this ratio is 0.9896. We found a transformation of entropy of the novel coronavirus infection which is explained by different proportions of patients with and without symptoms of the disease
Obstructive hypertrophic cardiomyopathy in association with chronic exudative pericarditis and COVID-19
No full textThe problem of comorbidity in elderly cardiac patients includes combinations of not only widespread but also rarer diseases that significantly aggravate each other and require all modern treatment options. Clinical case. We present a description of 2-year catamnesis of a 70-year old female patient suffering from obesity, hypertension, insulin-dependend diabetes, hyperuricemia with urolithiasis, systemic atherosclerosis, degenerative mitral and aortal stenosis, atrial fibrillation with cardiac pacemaker implantation, chronic heart failure, cerebral ischemia, chronic kidney disease, who was diagnosed obstructive hypertrophic cardiomyopathy at the age of 58 and pericardial effusion at the age of 69. The patient was first admitted to the clinic in April 2018 with pulmonary edema. Due to the marked obstruction at the level of the middle third of the left ventricle, alcohol ablation of the 1st septal branch was performed in June. The gradient decreased from 78 to 15-30 mm Hg, but this did not lead to a marked decrease in dyspnea. At the same time the volume of pericardial effusion increased from 300 ml to 1 liter. In the first study of the item, PCR for the mycobacterium tuberculosis was positive, T-SPOT test was also positive. Repeated prescribing different tuberostatics were accompanied by mental retardation, an episode of sustained ventricular tachycardia. In July 2019, the ICD was implanted. The numerous appropriate shocks were detected, up to the electrical storm followed by a disseminated pulmonary lesion with respiratory failure in late 2019 (pulmonary embolism? tuberculosis? non-specific viral-bacterial pneumonia?). Due to the accumulation of serous hemorrhagic exudate in the pericardium (up to 2 liters maximum), three more punctures were performed. Repeated tests for tuberculosis were negative. In March 2020, 600 mg of triamcynolone was injected intrapericardially. In May 2020, she died from COVID-19 with bilateral pneumonia. The direct cause of death was cerebral infarction. No tumors or active pulmonary tuberculosis were detected in autopsy and no PCR was performed. Conclusion. In spite of obviously severe combination of hypertrophic cardiomyopathy and pericarditis with polyorgan pathology, application of the whole arsenal of medication and interventional treatment allows prolonging life of patients and improving its quality. However, the risk of an unfavourable course of new coronavirus infection in such patients is extremely high
Use of low-molecular weight heparin, transfusion and mortality in COVID-19 patients not requiring ventilation
No full textIt is still debated whether prophylactic doses of low-molecular- weight heparin (LMWH) are always effective in preventing Venous Thromboembolism (VTE) and mortality in COVID-19. Furthermore, there is paucity of data for those patients not requiring ventilation. We explored mortality and the safety/efficacy profile of LMWH in a cohort of Italian patients with COVID-19 who did not undergo ventilation. From the initial cohort of 422 patients, 264 were enrolled. Most (n = 156, 87.7%) received standard LMWH prophylaxis during hospitalization, with no significant difference between medical wards and Intensive Care Unit (ICU). Major or not major but clinically relevant hemorrhages were recorded in 13 (4.9%) patients: twelve in those taking prophylactic LMWH and one in a patient taking oral anticoagulants (p: n.s.). Thirty-nine patients (14.8%) with median age 75 years. were transfused. Hemoglobin (Hb) at admission was significantly lower in transfused patients and Hb at admission inversely correlated with the number of red blood cells units transfused (p < 0.001). In-hospital mortality occurred in 76 (28.8%) patients, 46 (24.3%) of whom admitted to medical wards. Furthermore, Hb levels at admittance were significantly lower in fatalities (g/dl 12.3; IQR 2.4 vs. 13.3; IQR 2.8; Mann–Whitney U-test; p = 0.001). After the exclusion of patients treated by LMWH intermediate or therapeutic doses (n = 32), the logistic regression showed that prophylaxis significantly and independently reduced mortality (OR 0.31, 95% CI 0.13–0.85). Present data show that COVID-19 patients who do not require ventilation benefit from prophylactic doses of LMWH
Immunoinformatics analysis to design novel epitope based vaccine candidate targeting the glycoprotein and nucleoprotein of Lassa mammarenavirus (LASMV) using strains from Nigeria
No full textLassa mammarenavirus (LASMV) is responsible for a specific type of acute viral hemorrhagic fever known as Lassa fever. Lack of effective treatments and counter-measures against the virus has resulted in a high mortality rate in its endemic regions. Therefore, in this study, a novel epitope-based vaccine has been designed using the methods of immunoinformatics targeting the glycoprotein and nucleoprotein of the virus. After numerous robust analyses, two CTL epitopes, eight HTL epitopes and seven B-cell epitopes were finally selected for constructing the vaccine. All these most promising epitopes were found to be antigenic, non-allergenic, nontoxic and non-human homolog, which made them suitable for designing the subunit vaccine. Furthermore, the selected T-cell epitopes which were found to be fully conserved across different isolates of the virus, were also considered for final vaccine construction. After that, numerous validation experiments, i.e. molecular docking, molecular dynamics simulation and immune simulation were conducted, which predicted that our designed vaccine should be stable within the biological environment and effective in combating the LASMV infection. In the end, codon adaptation and in silico cloning studies were performed to design a recombinant plasmid for producing the vaccine industrially. However, further in vitro and in vivo assessments should be done on the constructed vaccine to finally confirm its safety and efficacy. Communicated by Ramaswamy H. Sarma
The role of intergovernmental relations in response to a wicked problem: An analysis of the covid-19 crisis in the brics countries
No full textGlobally, policy environments have become increasingly more complex with the growth in the number of wicked problems, such as that posed by the COVID-19 pandemic. In their response to these problems, public administrations have, from necessity, become heavily reliant on their intergovernmental relations systems, as the challenges posed generally require multilevel responses. This paper analyzes the role of intergovernmental relations in shaping the responses of the BRICS countries when confronted with COVID-19. We develop an analytical framework to understand the dynamics of intergovernmental relations in these countries. Based on this we assess the capacity of the state and political systems to manage intergovernmental relations and ensure effective responses to the COVID-19 crisis. This framework is based on an analysis of three dimensions of the policy domain: the political and state system, formal and informal institutions, and the political alignment between them. Whilst state and political systems were found to be instrumental in formulating an immediate response to the crisis, informal institutions and political processes also played a prominent role in determining the extent to which strategies were implemented, particularly in countries that are more decentralized. Countries lacking the robust formal institutions needed to facilitate intergovernmental relations and to ensure swift policy responses, tend to deliver ineffective and inefficient results when confronted with wicked problems
The Lessons of Forced Distance Learning: Software Engineering Approach in the Gap of Generations of Educational Software
No full textQuite recently, considerable attention has been paid to distance learning due to mass schools and universities closing because of coronavirus disease. This fact brought to light not only strengths but also weaknesses of existing educational software and use cases. This paper is motivated by the questions which are rinsed by thoroughly adopted educational software and the deep gap between educational methodologies and up-to-date distributed information infrastructure capabilities. The lack of an engineering approach in the deployment of distance learning tools leads to both technological and methodological problems. We present exploratory analysis of data gathered from authority web sources. The significant ideological differences between educational software generations are discussed with special attention to non-cloud-based and cloud-based collaborative technologies and corresponding platforms. The authors conclude that the power of integration based on industry-wide interoperability standards is useful to solve current problems in distance education related to software
Specific therapy and emergency prevention of flu
No full textInfluenza A and B epidemics, occasionally pandemics, are characterized by high morbidity and mortality rates. In most cases, an uncomplicated disease ends with recovery, but unfavorable outcomes, up to lethal, are possible, especially in premature, low birth weight, infants and young children, old people, pregnant and postpartum women, with chronic diseases, immunocompromised, receiving salicylates and anticoagulants. The use of modern diagnostic methods allows early detection of patients with influenza, distinguishing them from the total number of patients with respiratory infections. This allows you to optimize the timing of the examination, avoid unnecessary prescription of antibiotics, and timely prescribe specific chemotherapy and chemoprophylaxis. During epidemics, in the presence of an epidemiological history, the conclusion of the clinician is decisive for the diagnosis. Vaccination is an excellent method of preventing or relieving the flu. However, in case of an unfavorable course of the disease, in risk groups, in closed groups, it is recommended to use chemotherapy, pre-exposure or post-exposure chemoprophylaxis. Numerous studies have proven the effectiveness of the use of the drug oseltamivir, a specific blocker of the virus neuraminidase. As a result, its replication stops. The drug does not complicate the vaccination, it can be used in vaccinated people, in all age groups, is available in different dosages, and can be used with food. Treatment for uncomplicated influenza lasts 5 days. In certain situations, chemoprophylaxis and chemotherapy with the specific antiviral drug oseltamivir can help control influenza outbreaks in certain populations
The year of Сrises: How 2020 will reshape the structure of international relations
No full textThe decline of the U.S.-led liberal world order revealed the changes in the international system several years before the recent crises. The central argument in this article is that the COVID-19 humanitarian crisis, the crisis of the political elite in the West and the looming economic crisis have reinforced the structural shifts attributing to the decline of Pax Americana and further diffusion of power. This paper discusses the impact of the 2020 crises on the structure of international relations and aims to illuminate the relationship between the structural shifts and current struggle among the great powers. Today the international system succumbs to more disorder and entropy, while the U.S. tries to balance out China’s growth and contain militarily strong Russia. In their turn, Russia and China seek to dismantle the U.S.-led international order. Hence, since the current international system bears both nonpolarity and multipolarity features, it seems reasonable to compare the two concepts in order to identify contemporary shifts in the theoretical framework. This paper offers a unit-level analysis of the internal crises in the United States, China, Russia, the European Union, and Germany, and evaluates their international capabilities using a comparative analysis as the primary method. At the same time, the paradigmatic debate in this paper is mostly represented by the Realist school of political thought