Association of HLA Class I Genotype with Mortality in Patients with Diabetes Mellitus and COVID-19

Numerous studies showed that diabetes mellitus (DM) increases the risk of death from COVID-19 by five times. It is generally accepted that the high lethality of COVID-19 against the background of DM is due to the main complications of this disease: micro- and macroangiopathies, as well as heart and kidney failure. In addition, it was shown that acute respiratory viral infection increases the production of interferon gamma, increases muscle resistance to insulin, and modulates the activity of effector CD8+ T cells. The ability of CD8+ T cells to recognize SARS-CoV-2-infected cells depends not only on humoral factors but also on individual genetic characteristics, including the individual set of major histocompatibility complex class I (MHC-I) molecules. In this study, the relationship of the MHC-I genotype of patients with DM aged less than 60 years with the outcome of COVID-19 was studied using a sample of 222 patients. It was shown that lethal outcomes of COVID-19 in patients with DM are associated with the low affinity of the interaction of an individual set of MHC-I molecules with SARS-CoV-2 peptides.

Relationship of Covid-19 Severity with SARS-CoV-2 NS8 Protein Mutations Depending on Virus Strain

In mid-2021, the Delta strain of SARS-CoV-2 caused the third wave of the COVID-19 pandemic. Huge efforts have been devoted to studying the effect of its mutations on the effectiveness of neutralizing antibodies. Much less attention was paid to the individual features of the presentation of its peptides by molecules of the major histocompatibility complex class I (MCHC-I). In this study, the correlation of the HLA-I genotype of patients under the age of 60 years with the severity of COVID-19 caused by the two most common variants of the SARS-CoV-2 Delta strain in the summer of 2021: AY.122 and B.1.617.2 was studied. Analysis of the severity of the course of COVID-19 revealed a more severe course of the disease caused by the AY.122 variant. Comparison of the mutation profile of the two most common variants of the Delta strain showed that that the G8R mutation in the NS8 protein makes the greatest contribution to the ability of MHC-I to present viral peptides. Given that the NS8 protein is able to suppress the maturation of MHC-I molecules, the appearance of a mutation in one of its immunogenic epitopes could make a significant contribution to the prevalence of the AY.122 variant in the Russian population.

[Difficulties in the diagnosis of stroke in pregnant women]

AIM

To study the features of the clinical picture of stroke and results of laboratory/instrumental study in pregnant women.

MATERIAL AND METHODS

A study included 44 women at different periods of gestation (mean age 33.4±9.7 years) with clinical symptoms of stroke hospitalized within 4-11h after stroke. Neuroimaging, clinical/instrumental and laboratory examinations were carried out in the first 40 min after admission.

RESULTS

A routine screening examination during the management of pregnancy in women's consultation clinics does not always reduce the risk of life threatening events. The operative delivery can decrease the severity of the focal neurological deficit. Intensive treatment and dynamic management of patients with intracranial pathology in intensive care stroke unit improves outcome of stroke.

CONCLUSION

A timely differential diagnosis of pathological conditions with different symptoms of stroke at the different stages of medical care of pregnant women helps to choose an optimal treatment plan and improve the outcome.

[Hemodynamic monitoring from the data of intracardiac and transesophageal echocardiography]

The constantly increasing complexity and duration of surgical intervention, comorbidity that leads to severe circulatory and respiratory disorders, multifactoriness of functional and metabolic disorders--this also needs a rapid and accurate assessment of patients and objective monitoring. The value of monitoring is determined by the results of timely diagnosis of disorders and the prevention of severe complications, including circulatory arrest, regional and global systolic function of the ventricles, which undoubtedly assists in choosing the tactic of intensive care. Intracardiac echocardiography makes it possible to record changes in cardiac cavity volume in real time, to calculate ejection fraction as the major pump coefficient, which is of prime importance in the surgical correction of coronary circulation with one-stage correction of mitral insufficiency. Imaging of cardiac cavities, evaluation of valve apparatus function, timely diagnosis of myocardial contractility, by detecting the areas of a pathological condition, are main criteria for undertaking medical measures and choosing a treatment policy.