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Advanced Neurology Cerebrovascular pathology biomarkers in post-COVID-19 patients

factors such as delayed medical assistance, low health- COVID-19 1 – 1.5 years earlier (experimental group)
care accessibility, and other medical conditions, especially and 20 patients with CVD who did not have a COVID-
during the beginning of the pandemic. Mechanisms 19 infection during this period (comparison group). Both
explaining the unique association between SARS-CoV-2 groups were representative in terms of age and gender
and CVD include increased thromboxane synthesis with (Table 1).
associated platelet activation, rapid fibrinogen turnover, The Committee on Ethics and Deontology at the Institute
endothelial dysfunction, and inflammation. After of Neurology, Psychiatry and Narcology of the National
infection, the SARS-CoV-2 adhesion protein activates Academy of Medical Sciences of Ukraine approved the
platelets through platelet angiotensin-converting enzyme study at meeting No. 12 on December 15, 2023. This study
2 (ACE2) receptors, leading to increased expression of was deemed to meet the moral and ethical norms specified
platelet integrin αIIbβ3 and P-selectin, which promotes in the Helsinki Declaration of Human Rights, the Council
platelet degranulation and aggregation. In addition, the of Europe Convention on Human Rights and Biomedicine,
7
vascular endothelium is highly susceptible to viremia due and relevant laws of Ukraine.
to the surface expression of ACE2 receptors, which allows
the virus to enter, activate, and destroy endothelial cells. The criteria for inclusion of patients in this study were
8
In parallel with these pathways responsible for platelet the presence of CVD (specifically small vessel disease), age
activation and endothelial dysfunction, SARS-CoV-2 40 – 50 years, and history of COVID-19 1 – 1.5 years earlier
indirectly activates factor X through inflammatory (for patients in the experimental group) or no history
mediators, particularly interleukin (IL)-6 and IL-8, which of COVID-19 (for patients in the comparison group).
increase the expression of tissue factor, thereby activating Exclusion criteria included the absence of CVD and an
the extrinsic pathway. 9 age outside the 40 – 50 year range. The study also excluded

The neurogenic pathway of SARS-CoV-2 penetration patients with acute stroke. The severity of COVID-
into central nervous system neurons is associated with 19 was assessed subjectively depending on established
ACE2 receptors in the olfactory bulbs, leading to subsequent information about the duration of oxygen support during
damage to the hypothalamus. Neurological disorders do the acute course of the disease. Assessment of blood serum
not disappear without a trace and can persist indefinitely biomarkers was carried out before and after standard
due to structural changes in the brains of patients. In post- complex therapy for 14 days in the institute’s hospital.
COVID-19 patients, a range of pathological conditions, 2.3. Standard complex therapy of the patients
such as chronic non-specific inflammation involving
cytokines, endotheliitis, pneumonia, and blood–brain The types of CVD in the study included hypertension of
barrier damage, are observed. SARS-CoV-2 can also cause varying degrees in combination with atherosclerosis, treated
severe brain damage (stroke, encephalitis, etc.) in patients according to small vessel disease protocol. Treatment of these
suffering from neurological disorders. Therefore, the chronic pathologies began upon hospital admission against
monitoring of biochemical markers in patients with CVD the background of worsening cerebrovascular manifestations,
who have suffered from COVID-19 remains relevant. in accordance with local treatment protocols. The standard
complex therapy for patients in both the experimental and
The aim of the study was to determine the biochemical comparison groups included drugs to address intracellular
markers in the blood serum of patients with CVD who
had suffered from COVID-19, throughout the dynamics Table 1. Characteristics of the patients of the experimental
of their treatment. group and the comparison group involved in the study
2. Materials and methods Indicator Experimental Comparison
group group
2.1. Materials
Number of patients (n) 24 20
The reagent kits used in this study included the human Gender 46% ♂ : 54% ♀ 50% ♂ : 50% ♀
IL-6 enzyme-linked immunosorbent assay (ELISA) kit, Age (years) 44±4 43±4
human endothelin 1 (ET-1) ELISA kit, and human vascular
endothelial cell growth factor A (VEGF-A) ELISA kit (all Duration of COVID-19 (years) 1.15±0.21 -
kits were procured from Elabscience, USA). Severity of COVID-19 58% mild : 29% -
moderate : 13%
2.2. Characteristics of the patients severe
The study was conducted from February 14 to September Availability of vaccination 58% yes: 42% no 45% yes: 55% no
26, 2023. It included 24 patients with CVD who had Duration of treatment (days) 12±2 14±3

Volume 3 Issue 2 (2024) 2 doi: 10.36922/an.2878