Наукові праці. Кафедра дитячих інфекційних хвороб
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Item Історія кафедри інфекційних хвороб харківського національного медичного університету в подіях і персоналіях. Погляд крізь століття(2023-11-21) Капустник, Валерій Андрійович; Юрко, Катерина Володимирівна; Козько, Володимир Миколайович; Градиль, Григорій Іванович; Меркулова, Ніна Федірівна; Ткаченко, Віталій Григорович; Соломенник, Ганна Олегівна; Могилинець, Олена ІванівнаВисвітлено основні події та персоналії в історії кафедри інфекційних хвороб Харківського національного медичного університету за 100 років її існування.Item Патогістологія печінки як основа морфологічної діагностики хронічного гепатита С: запалення та дистрофія(2023-08) Юрко, Катерина Володимирівна; Щасна, Ія Олексіївна; Cоломенник, Ганна Олегівна; Гаврилов, Анатолій ВікторовичУ статті розглядаються питання клінічної морфології печінки при хронічному гепатиті С. Приділено увагу таким патологічним процесам, як запалення та дистрофія. Саме вони є передумовою подальшого розвитку некрозу та фіброзу печінки, які визначають тяжкість хронічного гепатиту С і зумовлюють несприятливі наслідки хвороби. Визначення ступеня запально-некротичного процесу є однією з діагностичних задач під час ведення пацієнта з даною патологією.Item Значення відносного рівня лімфоцитів у прогнозуванні активації латентної форми герпесвірусної інфекції в дітей хворих на ротавірусний гастроентерит(Науково-практична конференція "Мечниковські читання – 2023", 2023-11-03) Слєпченко, Маргарита Юріївна; Колесник, Яна Володимирівна; Ольховська, Ольга МиколаївнаItem Liver injury in hospitalized patients with COVID-19: An International observational cohort study(2023-09-13) Gavrylov, Anatoliy; Tieroshyn, Vadym; Vijayaraghavan, B.K.T.; Bishnu, S.; Baruch, J.; Zayyad, H.; Zucman, D.Background. Using a large dataset, we evaluated prevalence and severity of alterations in liver enzymes in COVID-19 and association with patient-centred outcomes. Methods. We included hospitalized patients with confirmed or suspected SARS-CoV-2 infection from the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) database. Key exposure was baseline liver enzymes (AST, ALT, bilirubin). Patients were assigned Liver Injury Classification score based on 3 components of enzymes at admission: Normal; Stage I) Liver injury: any component between 1-3x upper limit of normal (ULN); Stage II) Severe liver injury: any component ≥3x ULN. Outcomes were hospital mortality, utilization of selected resources, complications, and durations of hospital and ICU stay. Analyses used logistic regression with associations expressed as adjusted odds ratios (OR) with 95% confidence intervals (CI). Results. Of 17,531 included patients, 46.2% (8099) and 8.2% (1430) of patients had stage 1 and 2 liver injury respectively. Compared to normal, stages 1 and 2 were associated with higher odds of mortality (OR 1.53 [1.37–1.71]; OR 2.50 [2.10–2.96]), ICU admission (OR 1.63 [1.48–1.79]; OR 1.90 [1.62–2.23]), and invasive mechanical ventilation (OR 1.43 [1.27–1.70]; OR 1.95 (1.55–2.45). Stages 1 and 2 were also associated with higher odds of developing sepsis (OR 1.38 [1.27–1.50]; OR 1.46 [1.25–1.70]), acute kidney injury (OR 1.13 [1.00–1.27]; OR 1.59 [1.32–1.91]), and acute respiratory distress syndrome (OR 1.38 [1.22–1.55]; OR 1.80 [1.49–2.17]). Conclusions. Liver enzyme abnormalities are common among COVID-19 patients and associated with worse outcomes.Item Association of Country Income Level With the Characteristics and Outcomes of Critically Ill Patients Hospitalized With Acute Kidney Injury and COVID-19(2023-08) Gavrylov, Anatoliy; Tieroshyn, Vadym; Wainstein, M.; Spyrison, Nicholas; Dai, Danyang; Ghadimi, Moji; Chávez-Iñiguez, Jonathan S.; Rizo-Topete, Lilia; Citarella, Barbara Wanjiru; Merson, Laura; Pole, Jason D.; Claure-Del, Granado Rolando; Johnson, David W.; Shrapnel, SallyIntroduction: Acute kidney injury (AKI) has been identified as one of the most common and significant problems in hospitalized patients with COVID-19. However, studies examining the relationship between COVID-19 and AKI in low- and low-middle income countries (LLMIC) are lacking. Given that AKI is known to carry a higher mortality rate in these countries, it is important to understand differences in this population. Methods: This prospective, observational study examines the AKI incidence and characteristics of 32,210 patients with COVID-19 from 49 countries across all income levels who were admitted to an intensive care unit during their hospital stay. Results: Among patients with COVID-19 admitted to the intensive care unit, AKI incidence was highest in patients in LLMIC, followed by patients in upper-middle income countries (UMIC) and high-income countries (HIC) (53%, 38%, and 30%, respectively), whereas dialysis rates were lowest among patients with AKI from LLMIC and highest among those from HIC (27% vs. 45%). Patients with AKI in LLMIC had the largest proportion of community-acquired AKI (CA-AKI) and highest rate of in-hospital death (79% vs. 54% in HIC and 66% in UMIC). The association between AKI, being from LLMIC and in-hospital death persisted even after adjusting for disease severity. Conclusions: AKI is a particularly devastating complication of COVID-19 among patients from poorer nations where the gaps in accessibility and quality of healthcare delivery have a major impact on patient outcomes.Item The influence of the epstein-barr virus on paraclinical indicators and cytokine levels in children with rotavirus gastroenteritis(2023-02-22) Sliepchenko, Marharyta; Olkhovska, OlgaItem Thrombotic and hemorrhagic complications of COVID-19 in adults hospitalized in high-income countries compared with those in adults hospitalized in low- and middle-income countries in an international registry(2023-01-25) Gavrylov, Anatoliy; Tieroshyn, Vadym; Griffee, M.J.; Bozza, P.T.; Reyes, L.F.; Zoufaly, A.; Zucman, D.; ISARIC Clinical Characterisation GroupBackground: COVID-19 has been associated with a broad range of thromboembolic, ischemic, and hemorrhagic complications (coagulopathy complications). Most studies have focused on patients with severe disease from high-income countries (HICs). Objectives: The main aims were to compare the frequency of coagulopathy complications in developing countries (low- and middle-income countries [LMICs]) with those in HICs, delineate the frequency across a range of treatment levels, and determine associations with in-hospital mortality. Methods: Adult patients enrolled in an observational, multinational registry, the International Severe Acute Respiratory and Emerging Infections COVID-19 study, between January 1, 2020, and September 15, 2021, met inclusion criteria, including admission to a hospital for laboratory-confirmed, acute COVID-19 and data on complications and survival. The advanced-treatment cohort received care, such as admission to the intensive care unit, mechanical ventilation, or inotropes or vasopressors; the basic-treatment cohort did not receive any of these interventions. Results: The study population included 495,682 patients from 52 countries, with 63% from LMICs and 85% in the basic treatment cohort. The frequency of coagulopathy complications was higher in HICs (0.76%-3.4%) than in LMICs (0.09%-1.22%). Complications were more frequent in the advanced-treatment cohort than in the basic-treatment cohort. Coagulopathy complications were associated with increased in-hospital mortality (odds ratio, 1.58; 95% CI, 1.52-1.64). The increased mortality associated with these complications was higher in LMICs (58.5%) than in HICs (35.4%). After controlling for coagulopathy complications, treatment intensity, and multiple other factors, the mortality was higher among patients in LMICs than among patients in HICs (odds ratio, 1.45; 95% CI, 1.39-1.51). Conclusion: In a large, international registry of patients hospitalized for COVID-19, coagulopathy complications were more frequent in HICs than in LMICs (developing countries). Increased mortality associated with coagulopathy complications was of a greater magnitude among patients in LMICs. Additional research is needed regarding timely diagnosis of and intervention for coagulation derangements associated with COVID-19, particularly for limited-resource settings.Item Characteristics and outcomes of an international cohort of 600 000 hospitalized patients with COVID-19(2023-02-28) Gavrylov, Anatoliy; Tieroshyn, Vadym; Kartsonaki, C.; Baillie, J.K.; Barrio, N.G.; Zoufaly, A.; Zucman, D.; ISARIC Clinical Characterisation GroupBackground: We describe demographic features, treatments and clinical outcomes in the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) COVID-19 cohort, one of the world’s largest international, standardized data sets concerning hospitalized patients. Methods: The data set analysed includes COVID-19 patients hospitalized between January 2020 and January 2022 in 52 countries. We investigated how symptoms on admission, co-morbidities, risk factors and treatments varied by age, sex and other characteristics. We used Cox regression models to investigate associations between demographics, symptoms, co-morbidities and other factors with risk of death, admission to an intensive care unit (ICU) and invasive mechanical ventilation (IMV). Results: Data were available for 689 572 patients with laboratory-confirmed (91.1%) or clinically diagnosed (8.9%) SARS-CoV-2 infection from 52 countries. Age [adjusted hazard ratio per 10 years 1.49 (95% CI 1.48, 1.49)] and male sex [1.23 (1.21, 1.24)] were associated with a higher risk of death. Rates of admission to an ICU and use of IMV increased with age up to age 60 years then dropped. Symptoms, co-morbidities and treatments varied by age and had varied associations with clinical outcomes. The case-fatality ratio varied by country partly due to differences in the clinical characteristics of recruited patients and was on average 21.5%. Conclusions: Age was the strongest determinant of risk of death, with a 30-fold difference between the oldest and youngest groups; each of the co-morbidities included wasassociated with up to an almost 2-fold increase in risk. Smoking and obesity were also associated with a higher risk of death. The size of our international database and the standardized data collection method make this study a comprehensive international description of COVID-19 clinical features. Our findings may inform strategies that involve prioritization of patients hospitalized with COVID-19 who have a higher risk of death.Item Neurological manifestations of COVID-19 in adults and children(2023-10-16) Gavrylov, Anatoliy; Tieroshyn, Vadym; Cho, S.-M.; White, N.; Premraj, L.; Zoufaly, A.; Zucman, D.; ISARIC Clinical Characterisation Group; Battaglini, Denise; Fanning, Jonathon; Suen, Jacky; Li Bassi, Gianluigi; Fraser, John; Robba, Chiara; Griffee, Matthew; Singh, Bhagteshwar; Citarella, Barbara Wanjiru; Merson, Laura; Solomon, Tom; Thomson, DavidDifferent neurological manifestations of coronavirus disease 2019 (COVID-19) in adults and children and their impact have not been well characterized. We aimed to determine the prevalence of neurological manifestations and in-hospital complications among hospitalized COVID-19 patients and ascertain differences between adults and children. We conducted a prospective multicentre observational study using the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) cohort across 1507 sites worldwide from 30 January 2020 to 25 May 2021. Analyses of neurological manifestations and neurological complications considered unadjusted prevalence estimates for predefined patient subgroups, and adjusted estimates as a function of patient age and time of hospitalization using generalized linear models. Overall, 161 239 patients (158 267 adults; 2972 children) hospitalized with COVID-19 and assessed for neurological manifestations and complications were included. In adults and children, the most frequent neurological manifestations at admission were fatigue (adults: 37.4%; children: 20.4%), altered consciousness (20.9%; 6.8%), myalgia (16.9%; 7.6%), dysgeusia (7.4%; 1.9%), anosmia (6.0%; 2.2%) and seizure (1.1%; 5.2%). In adults, the most frequent in-hospital neurological complications were stroke (1.5%), seizure (1%) and CNS infection (0.2%). Each occurred more frequently in intensive care unit (ICU) than in non-ICU patients. In children, seizure was the only neurological complication to occur more frequently in ICU versus non-ICU (7.1% versus 2.3%, P<0.001). Stroke prevalence increased with increasing age, while CNS infection and seizure steadily decreased with age. There was a dramatic decrease in stroke over time during the pandemic. Hypertension, chronic neurological disease and the use of extracorporeal membrane oxygenation were associated with increased risk of stroke. Altered consciousness was associated with CNS infection, seizure and stroke. All in-hospital neurological complications were associated with increased odds of death. The likelihood of death rose with increasing age, especially after 25 years of age. In conclusion, adults and children have different neurological manifestations and in-hospital complications associated with COVID-19. Stroke risk increased with increasing age, while CNS infection and seizure risk decreased with age.Item Features of the structural and functional state of blood lymphocytes in patients with infectious mononucleosis with different course(2023-01) Kolesnyk, Yana; Olkhovska, Olga; Sorokina, OlgaThe relevance of the problem of infectious mononucleosis (IM) is determined by the high level of Epstein-Barr virus (EBV) infection in children, the possibility of developing an unfavorable course of the disease and, in some cases, the formation of long-term immunosuppression with a deficiency of T-cell and phagocytic immunity. The available literature clearly highlights the issues of etiology, pathogenesis and clinical manifestations of the disease. However, scientists' data on the early diagnosis of infectious mononucleosis are rather contradictory. Untimely diagnosis of active forms of EBV infection, and hence untimely treatment, can lead to uncontrolled proliferation of B-lymphocytes, which is a causative factor in the malignancy of EBV-infected cells with the development of lymphoproliferative diseases.