Abstract: Introduction: Nowadays, the coronavirus disease COVID-19 is a global problem for the population of the whole world which has acquired the character of a pandemic. Under physiological conditions, in a healthy person, erythrocytes make up 96% of all blood cells, leukocytes 3%, and hrombocytes about 1%. In healthy individuals, erythrocytes are mostly shaped like a biconcave disc and do not contain a nucleus. The diameter of the erythrocyte is 8 microns, but the peculiarities of the cell structure and the membrane structure ensure their great ability to deform and pass through capillaries with a narrow lumen of 2-3 microns. Therefore, the study of the morpho-functional state of blood cells, namely erythrocytes, in this category of patients is relevant and deserves further research.

The Aim: To figure out the effect of the coronavirus disease COVID-19 on the ultrastructural blood cell changes, in particular erythrocytes, in patients with ischemic heart disease (IHD) and diabetes mellitus type 2.

Materials and Methods: Twelve patients with COVID-19 who had an acute myocardial infarction were examined. The comparison group consisted of 10 people with acute myocardial infarction without symptoms of COVID-19. The average age of the patients was 62 ± 5,6 years. The functional state and ultrastructure of blood cells were studied using electron microscopy.

Results: In the presence of COVID-19, we detected both calcification and destruction of erythrocytes and platelets. Reticulocytes were detected much more often in these individuals than in the comparison group. In patients with acute myocardial infarction in the presence of type 2 diabetes and COVID-19, a significant number of markedly deformed, hemolyzed erythrocytes or with signs of acanthosis, which stuck together and with other destructively changed blood cells, were found. We also detected «neutrophils extracellular traps» (NETs).

Conclusions: Morphological changes of blood cells in COVID-19 varied according to the disease course and severity especially in the background of a weakened immune system in older and elderly people, in the presence of diabetes, excessive body weight, cardiovascular diseases and occupational hazards. Under the influence of COVID-19, blood cells are destroyed by apoptosis and necrosis. Therefore, hypoxia and ischemia of vital organs of the human body occur.

Резюме. Постковідний синдром є мультисиндромальним клінічним станом унаслідок залучення багатьох систем людського організму, ураження яких відбувається навіть після легкого чи безсимптомного перебігу гострого COVID-19. У статті висвітлено класифікацію та критерії діагностики постковідних станів, їх основні клінічні прояви, патогенетичні механізми розвитку ускладнень і напрямки реабілітації пацієнтів. Ключові слова: коронавірусна хвороба, постковідний синдром, ускладнення, реабілітація, вірус SARS-CoV-2.

Abstract. Post-COVID syndrome is a multi-syndromal clinical condition, involving many systems of the human body, even after a mild or asymptomatic course of acute COVID-19. The article provides an overview of the classification and diagnostic criteria of post-COVID conditions, the main clinical manifestations, pathogenetic mechanisms of the development of complications and directions for rehabilitation of patients. Keywords: coronavirus disease, post-COVID syndrome, complications, rehabilitation, SARS-CoV-2 virus.

The presented article shows the importance of using such additional clinical markers of the development of pathological and critical conditions as non-specific adaptive reactions, which are integral indicators of the imbalance of all homeostatic systems of the body. The purpose of the study was to establish the types of non-specific adaptive reactions, to take into account changes in the ratio of cellular parameters of peripheral blood, and to use them to improve the effectiveness of diagnosis and treatment of ST-elevation myocardial infarction (STEMI). The results of examinations in three research groups (79 patients) were analyzed: Group I - 28 patients with STEMI and normal body weight, Group II - 24 patients with STEMI and excess body weight, and Group III - 27 patients with STEMI and obesity of the I-III degrees. The diagnosis (acute coronary syndrome) of ACS was made based on a complex clinical, laboratory and instrumental examination. Blood was taken for the study when patients were admitted to the department. The total number of leukocytes and the leukocyte blood formula were determined by standardized methods; the type of non-specific adaptation reaction - according to the method of L.H. Harkavi; the ratio of the absolute content of neutrophils to the absolute content of lymphocytes (neutrophil to lymphocyte ratio, NLR), and the ratio of the absolute content of neutrophils to the absolute content of platelets (neutrophil to platelet ratio, NPR) was determined. The course of ACS occurs against the background of several non-specific adaptation reactions, where the stress reaction was dominant (42.8% - group I, 50% - group II, and 51.9% - group III), indicating the disease's severity. The highest level of NLR (p<0.05) was found in group III, relative to the NLR indicator in group I and group II, and the highest level of NPR was found in group III precisely in case of a stress reaction, which indicates an unfavourable prognosis for patients of this group. Determining the type of nonspecific adaptation reaction can serve as an additional indicator of the severity of the patient and allows us to assess the effectiveness of therapy in patients with STEMI. The indicators of NLR and NPR were useful and powerful indicators of adverse consequences during the hospitalization of patients with ACS. The type of adaptive response and the indicators of NLR and NPR are determined based on clinical blood analysis indicators, and they are economical biomarkers for predicting the severity of inflammation.

Мета дослідження — вивчити показники якості життя пацієнтів із гострим інфарктом міокарда (ГІМ) за наявності надмірної маси тіла (НМТ) та ожиріння із використанням міжнародного опитувальника EuroQol-5D-5L для оцінки якості життя. Матеріал і методи. Обстежено 158 пацієнтів із ГІМ з елевацією сегмента ST (ГІМелST) віком від 32 до 86 років. Усі пацієнти були розподілені на 3 групи: першу групу становили 52 особи з ІМ із нормальною масою тіла (індекс маси тіла (ІМТ) — 18,5-24,9 кг/м2), другу групу — 51 пацієнт з ІМ та НМТ (ІМТ — 25,0-29,9 кг/м2), третю групу — 55 осіб з ІМ та ожирінням І-ІІІ ступенів (ІМТ≥30,0 кг/м2). Результати. Порівняння результатів окремих показників опитувальника показало, що при госпіталізації суб’єктивні показники усіх компонентів опитувальника були достовірно гіршими в пацієнтів ІІ і ІІІ груп порівняно з особами І групи (p<0,05). Виявлено, що через 10 днів після початку лікування суб’єктивні показники догляду за собою не відрізнялися (р>0,05) між групами. Рухливість, звичайна повсякденна діяльність, біль/дискомфорт та тривога/депресія достовірно більше турбували пацієнтів ІІІ групи, порівняно з хворими І групи (р1-3<0,05), достовірної різниці між цими показниками при порівнянні осіб ІІ і ІІІ груп не виявлено (р2-3>0,05). При госпіталізації достовірно більше пацієнтів групи ІІ (з НМТ) та ІІІ (з ожирінням) відмічали наявність помірної тривоги або депресії порівняно з особами групи І (з нормальною масою тіла) (р1-2<0,01, р1-3<0,01). На 10-й день спостереження достовірно більше пацієнтів із нормальною масою тіла (78,85% — група І) відзначили, що не відчувають тривоги або депресії порівняно з особами з НМТ (50,93% — група ІІ) та ожирінням (46,94% — група ІІІ) (р1-2<0,01, р1-3<0,01). Висновки. Ожиріння і надмірна маса тіла є важливими чинниками погіршення якості життя при гострому інфаркті міокарда з елевацією сегмента ST навіть після ефективно проведеної реперфузійної терапії. Перебіг інфаркту міокарда за наявності надмірної маси тіла та ожиріння супроводжується більш вираженими проявами тривоги/депресії, тому, імовірно, слід використовувати методи психокорекції з метою підвищення ефективності лікування й покращення якості життя таких пацієнтів.

The aim of the study was to examine the quality of life in patients with AMI in the presence of overweight and obesity using the international questionnaire EuroQol-5D-5L to assess quality of life. Material and methods. 158 patients with ST-elevation myocardial infarction (STEMI) age from 32 to 86 years were examined. All patients were divided into 3 groups: first group consisted of 52 people with normal body weight (body mass index (BMI) — 18.5-24.9 kg/m2), second group — 51 people with overweight (BMI 25.0-29.9 kg/m2), third group — 55 people with obesity of I-III stages (BMI≥30.0 kg/m2). Results. Comparison of the questionnaire individual indicators results showed that when hospitalized the patients of the groups II and III presented significantly worse subjective indicators results in all components of the questionnaire than the patients of the group I (p<0.05). It was found that 10 days after the start of the treatment, subjective indicators of self-care did not differ (p>0.05) between the groups. Mobility, normal daily activities, pain/discomfort and anxiety/depression were probably more disturbing for patients of the group III than for patients of group I (p1-3<0.05), no significant difference between these indicators was found when comparing persons of the groups II and III p2-3>0.05). At hospitalization, significantly more patients of the group II (overwight) and III (obesity) noted the presence of moderate anxiety or depression compared with persons of the group I (normal body weight) (p1-2<0.01, p1-3<0.01 ). On the 10th day of the follow-up, significantly more patients with normal body weight (78.85% — group I) reported that they did not experience anxiety or depression compared to persons with overwight (50.93% — group II) and obesity (46.94% — group III) (p1-2<0.01, p1-3<0.01). Conclusions. Obesity and overweight are important factors in the deterioration of quality of life in acute myocardial infarction with ST-segment elevation, even after effective reperfusion therapy. The course of acute myocardial infarction in the presence of overweight and obesity is accompanied by a more severe depression, so it is likely to use psychocorrection methods to improve the effectiveness of treatment and improve a quality of life of such patients.

The aim: To determine the diagnostic value of serum levels of ST2 in patients with the acute coronary syndrome (ACS) and its correlation with NT-proBNP levels. Materials and methods: NT-proBNP and ST2 concentration in serum of patients was measured on admission to the hospital and on the 10th day of the treatment using NT-proBNP ELISA (Biomedica, Slovakia) and Presage ST2 assay (Critical Diagnostics, USA), respectively. Results: Statistically significant direct correlations (p<0.05). The simultaneous increase of ST2 and NT-proBNP serum levels above their threshold in patients with ACSelST (sensitivity – 92.5 %, specificity – 74.2 %, AUC – 0.893, р<0.05) indicated a significant risk of cardiovascular (CV) complications of acute myocardial infarction (AMI) during the inpatient period, e.g. acute heart failure, acute LV aneurysm, recurrent AMI, as well as rhythm and conductivity disturbances. Conclusions: The data suggest that both ST2 and NT-proBNP may prove useful in predicting unfavorable prognosis during the inpatient care of AMI, as the simultaneous increase of these biomarkers above their threshold values indicates a significant risk of CV complications.