The aim of the study was to determine the etiology and frequency of nosocomial infections in patients with severe and critical COVID-19.

Material and methods. A retrospective, single-center study included 168 patients with COVID-19 admitted to the intensive care unit (ICU). All episodes of infection, clinical and laboratory characteristics, and outcome were documented in patients.

Results. Hospital-acquired infections were detected in 82 (48.8%) of 168 patients, more frequently in men (p = 0.028).  A total of 232 episodes of nosocomial infections were observed including ventilator-associated pneumonia (48.2%), bloodstream infection (39.2%), nosocomial pneumonia/tracheobronchitis (13.4%), and urinary tract infection (5.2%). The main causative agents of nosocomial infections were resistant strains of Acinetobacter baumannii and Klebsiella pneumoniae. Infections developed on the average on day 6 [3; 9] of ICU stay and were associated with the initial severity of the patients assessed by SOFA (p=0.016), SpO₂ (p=0.005), lymphopenia severity (p=0.003), Neutrophil-Lymphocyte Ratio (p=0.004), C-reactive protein (p=0.01), aspartate aminotransferase (AST) level (p=0.022), or vitamin D (p=0.035) levels. Patients diagnosed with infection were more likely than those without infections to require mechanical ventilation (67.6% vs 32.4%, p < 0.001), high-flow oxygen therapy (50.0% vs 31.0%, p = 0.020), renal replacement therapy (36.8% vs 9.3%, p = 0.003), and had longer ICU length of stay (13 [9; 18] vs 4 [2; 8], p < 0.001), hospital length of stay (19 [14; 29] vs 15 [11; 20], p = 0.001) and mortality (47 (57.3%) vs 25 (29.0%), p < 0.001).

Conclusion. In patients with severe and critical COVID-19 a high incidence of nosocomial infections was found, which negatively affected the outcome. In more than half of the cases, the infection was caused by resistant strains of Gram-negative bacilli. Procalcitonin is a useful biomarker for identifying bacterial infection in patients with COVID-19.

The host immune response, primarily manifested by hypercytokinemia, obviously plays a key role in the development of severe novel coronavirus disease, COVID-19. Currently, numerous therapies aimed at suppressing the hyperinflammatory response and the "cytokine storm" are being investigated. One of these methods is the use of corticosteroids, particularly dexamethasone.

The aim was to assess the clinical efficacy of dexamethasone in patients with moderate bilateral multifocal pneumonia caused by SARS CoV-2 virus.

Material and methods. Sixty-nine patients aged from 31 to 88 years hospitalized in Almazov National Research Center and the Semashko City Hospital No 38 with SARS CoV-2 coronavirus infection complicated by moderate (semiquantitative visual pulmonary lesion grading system CT 2-3 corresponding to 25-50% and 50-75% parenchymal involvement, respectively) community-acquired bilateral multifocal pneumonia were retrospectively studied. Group 1 included 39 patients with moderate coronavirus infection who received therapy according to the current version of the temporary guidelines (TG) of the Ministry of Health of the Russian Federation, including dexamethasone. The drug was administered parenterally twice daily in a dosage of 12 mg in the morning and 8 mg in the evening for the first three days, then the dose was gradually reduced over 5-7 days. No Interleukin-6 inhibitors were administered to patients in this group. Group 2 was composed of 30 patients who received therapy according to the current version of TG, including a parenteral interleukin-6 inhibitor (tocilizumab, olokizumab, or sarilumab) following the standard regimen. Patients in this group were not administered with dexamethasone.

Results. CT scans corresponding to severity grade 3 and 4 (50-75% and >75% involvement, respectively) lung lesions on Day 7 were found in 35.89% of group 1 patients, while similar CT scans were found in 50% of patients who received interleukin-6 inhibitors (P=0.33). On Day 14 no significant differences in this parameter were revealed as well. Duration of fever in the dexamethasone group was 3.69 (0.62;6.76) days, while in the control group it was 3.95 (0.61;7.29) days (P=0.98). There was a tendency to decreased blood Creactive protein (CRP) values in the dexamethasone group on days 5 and 7. The frequency of transfer of patients to the ICU and hospital stay duration did not differ significantly between the groups.

Conclusion. Dexamethasone has comparable clinical efficacy with IL-6 antagonists in the comprehensive treatment of patients with moderate COVID-19 disease, which is confirmed by the chest CT evolution, duration of fever, and changes in serum CRP.

Large population studies using statistical analysis and mathematical computer modeling could be an effective tool in studying COVID-19. The use of prognostic scales developed using correlation of changes in clinical and laboratory parameters and morphological data, can help in early prediction of disease progression and identification of patients with high risk of unfavorable outcome.

Aim of the review. To assess the risk factors for severe course and unfavorable outcome of COVID-19 and to evaluate the existing tools for predicting the course and outcome of the novel coronavirus infection.
PubMed, Medline, and Google Scholar were searched for the relevant sources.
This review contains information on existing tools for assessing the prognosis and outcome of the disease, along with the brief data on the etiology, pathogenesis of the novel coronavirus infection and the known epidemiological, clinical and laboratory factors affecting its course.

Conclusion. It is essential to develop predictive models tailored to specific settings and capable of continuous monitoring of the situation and making the necessary adjustments. The discovery of new and more sensitive early markers and developing marker-based predictive assessment tools could significantly impact improving the outcomes of COVID-19.

The aim of the study was to investigate the feasibility of predicting the need for mechanical ventilation in patients with severe COVID-19 disease using ultrasound assessment of diaphragm function.

Material and methods. An open prospective pilot study included 60 patients diagnosed with the novel coronavirus infection, who, at the time of admission to the intensive care unit (NEWS score > 6), underwent ultrasound assessment of diaphragm excursion, thickness and the diaphragm thickening fraction. Group 1 (n=30) included patients who did not require mechanical ventilation, and group 2 (n=30) consisted of patients who were subsequently transferred to mechanical ventilation.

Results. Patients in group 2 had significantly lower diaphragm function parameters (left excursion value (P<0.001), right excursion value (P<0.001), diaphragm thickness on inspiration (P=0.043), and thickening fraction (P<0.001) than patients in group 1.

Conclusion. Decreased diaphragm excursion of less than 17.1 mm on the right side is a predictor of initiation of mechanical ventilation in patients with the COVID-19 infection (sensitivity 93.3%, specificity 76.7%). Morphological examination in deceased patients of group 2 revealed pericellular and perivascular edema, venular thrombosis, endoneurial edema, and sludge in the lumen of arterioles.

Aim of the study. To evaluate the risk factors for the occurrence of intramuscular hematomas in patients with severe coronavirus infection receiving anticoagulant therapy.

Materials and methods. Intramuscular hematomas in five patients with severe COVID-19 disease are reported in the paper. The criteria for selecting patients for the study included respiratory distress requiring oxygen, radiographic signs of severe pneumonia, anticoagulant therapy using low molecular weight heparin (LMWH), and spontaneous intramuscular hematoma. Clinical manifestations, blood coagulation results, conservative and surgical management were analyzed.

Results. Standard regimen anticoagulation therapy in patients with coronavirus infection requires vigilance because of a risk of development of hemorrhagic complications.

Сonclusion. When assessing a patient with hematomas, an emphasis should be given to examination of patients and changes in hemoglobin and hematocrit levels. Best strategy of anticoagulant therapy for patients with coronavirus infection and high risk of VTE, as well as optimal laboratory monitoring during LMWH administration are yet to be explored.