Zinc deficiency is highly prevalent ranging from 10% to 30–40% of the population in developed and developing countries respectively. Low zinc level has been found to be associated with 0.7% of overall mortality and 1.0% of disability-adjusted life years (DALYs) worldwide. In turn, available research evidence has shown that zinc supplementation in its deficiency can reduce the risk of preterm birth, promote the physical development of children, and have certain protective effect against the components of the metabolic syndrome. A positive effect of zinc supplementation on recovery from pneumonia, diarrhea, and common cold has been reported. It is expected that the most pronounced effect of zinc supplementation may be observed in individuals with subclinical or severe zinc deficiency. Due to the high incidence of zinc deficiency, as well as its significant contribution to a wide range of pathologies, the correction of low zinc level may be considered as economically effective strategy. Thus, the results of the existing studies have demonstrated the efficiency of zinc intake for prophylaxis or as an adjuvant therapy of a wide range of pathologies.

Acute cerebral circulation disorder is one of the most discussed issues in modern intensive care and neurology, as it is a severe condition, leading to disability or death of the patient, in the absence of immediate medical care. This review discusses general and specific biological markers of stroke, genetic markers of stroke, and current data on their diagnostic significance. The main mechanisms of brain tissue cell death in stroke, such as apoptosis, necrosis, ferroptosis, parthanatosis, sarmoptosis, autolysis, autophagy, oncosis, excitotoxic death are analyzed; the morphological features of the observed processes and their structural manifestations are reviewed. For each type of cell death in nervous tissue, the most frequently detected molecular markers are discussed: specific kinases, Toll-like receptors in the case of apoptosis; serine-threonine protein kinases, components of the polyubiquitin system detected in necrosis; transferrin 1 receptors, typical for ferroptosis; poly(ADP-ribose)-polymerase, whose activity increases in parthanatosis; slow Wallerian degeneration protein that accumulates during sarmoptosis; and other biomarkers characteristic of both individual types of nerve cell death and general pathological processes affecting the brain.

Recently, data have been published on the leading role of endothelial dysfunction in the development of severe COVID-19, including acute renal failure (AKI) and poor prognosis in this group of patients.

Aim. To define the role of angiopoetin-1(Ang-1) as a marker of endothelial dysfunction in development of AKI in patients, hospitalized with COVID-19.

Materials and methods. 76 patients with confirmed coronavirus infection were included in the study. AKI was diagnosed according to KDIGO 2012 criteria in 44 patients (group 1), 32 patients without sings of kidney disfunction were in group 2. Beside standard clinical and laboratory markers on admission we evaluated serum Ang-1 level with ELISA. We used regression analysis for AKI risk factors evaluation, we calculated odds ratio (OR) and 95% confidence intervals (CI). We used Cox regression for evaluation of risk of death.

Results. The serum level of angiopoietin-1 was significantly higher in patients with COVID-19 with AKI: 1.8 (1.5; 2.1) ng/ml vs 1.58 (1.29; 1.7) ng/ml in group 2, р < 0.01. In deceased patients, the level of Ang-1 at admission was significantly higher than in patients who was discharged: 1.91 (1.71; 2.32) ng/ml vs 1.58 (1.34; 1.67) ng/ml, respectively, p = 0.0001. In unifactorial regression analysis we confirmed, that increase of serum Ang-1 level >1.66 ng/ml on admission is the risk factor for AKI development in patients with COVID-19 (OR 5.7, 95% CI 1.7–19.1, р < 0.01). In Cox regression development of AKI increased the absolute risk of death: Hazard ratio = 5.159 (95% CI 1.839–14.469), p = 0.002.

Conclusion. The high serum level of Ang-1 in patients with COVID-19 at hospital admission is the marker of systemic endothelial dysfunction and the risk factor for AKI and poor prognosis.

Aim. To study serum concentrations of trace and macro elements and their correlations in children and adolescents after antitumor therapy, depending on the presence or absence of caries.

Materials and methods. The study included 98 patients aged 4 to 17 years who were in remission after an antitumor therapy performed for acute leukemia or lymphomas. Patients with carious tooth lesions were included in group 1 (n = 34) and without caries – in group 2 (n = 64). We used inductively coupled plasma mass spectrometry to calculate the content of essential, conditionally essential and toxic elements in blood serum. The median and interquartile range were calculated, the Mann-Whitney U-test was applied to compare groups, and the Kendall rank correlation coefficient (τ) was calculated for tandem elements.

Results. In both groups, the concentrations of the studied elements were within the reference ranges. In group 1, compared with group 2, higher concentrations of potassium, arsenic, iodine and boron and lower concentrations of lithium and tungsten (p < 0.05) were noted. There were no differences in the concentration of phosphorus, calcium, magnesium, manganese, gold, silver, platinum, aluminum, beryllium, bismuth, cadmium, cobalt, chromium, copper, iron, mercury, lithium, molybdenum, nickel, rubidium, antimony, tin, vanadium, zinc, zirconium and thallium between the groups. Significant correlation coefficients in both groups were obtained for the iron/manganese tandem (τ = 0.24, p < 0.05). Different values of τ were got for nickel/ manganese, cobalt/iron, manganese/phosphorus, beryllium/lithium tandems: τ = 0.342 and τ = 0.14; τ = 0.363 and τ = 0.033; τ = –0.111 and τ = –0.326; τ = –0.365 and τ = 0.42, respectively, for groups 1 and 2.

Conclusion. In patients in remission after antitumor therapy, an association of caries with an increase (within reference values) in the concentration of essential (potassium, iodine) and conditionally essential elements (arsenic, boron), a decrease in the concentration of lithium and tungsten; as well as a change in the ratio of nickel/manganese, cobalt/iron, manganese/ phosphorus and change the direction of the correlation in the beryllium/lithium tandem was revealed.

A significant part of distal cerebral aneurysms belongs to the category of complex. Traditional methods of shutting down such aneurysms are not applicable. Treatment tactics remain a subject of debate. The presence of COVID-19 complicates the course of the disease and complicates the routing of the patient to a specialized hospital.

Description of the case. A 36-year-old man with COVID-19 developed an ischemic stroke in the territory of the right middle cerebral artery (MСA), clinically manifested by dysarthria and pronounced left-sided hemiparesis. Cerebral angiography (CAG) revealed thrombosis of the parietal branch of the M2 segment of the right MСA with distal filling of the channel from the territory of the left MСA. After 3 months, according to the control CAG, recanalization of the M2 segment of the right MСA and fusiform aneurysm of this segment of the artery were diagnosed. To turn off the aneurysm, an intra-intracranial anastomosis was applied between the upper and lower M2 segments of the right MСA and an extra-intracranial anastomosis between the parietal branch of the right superficial temporal artery and the cortical branch from the territory of the compromised M3 segment of the MСA, the aneurysm was excised. The postoperative period was complicated by reinfection of SARS-CoV-2. After the treatment, the patient was discharged in a satisfactory condition without neurological deficit.

Discussion. Resection of an aneurysm with revascularization of the distal bed can be considered as the method of choice in patients with distal aneurysms if it is impossible to apply traditional clipping. The presence of COVID-19 infection increases the risk of thrombotic complications, imposes increased requirements on the technique of performing vascular anastomoses.