Introduction. Diabetes mellitus (DM) is the most common and incapacitating endocrine disorder. Diabetic foot syndrome (DFS) is one of the most serious complications of DM, which is the main cause of nontraumatic lower-extremity amputations. Despite the efforts of the entire medical community, the survival rate of DFS patients with non-healing ulcers and after foot surgery does not exceed 50% over 5 years and is comparable to the survival rates of patients with colorectal cancer.Aim. It has been demonstrated that postsurgical diabetic foot wounds tend to chronization of inflammatory process. The diabetic autonomic neuropathy can be involved in diabetic foot damages. We hypothesized that progression of cardiovascular autonomic neuropathy  (CAN) leads to aggressive microvascular complications of  diabetes and delay the  postsurgical wound healing in diabetic foot patients during 2 years of observation.Materials and methods. We examined 94 outpatients with postsurgical diabetic foot wounds and observation period of two years. The clinical neurological examination and standard cardiovascular autonomic reflex tests with identification of severe/advanced abnormalities were performed at baseline and after 2 years. The progression of CAN was diagnosed in cases of an increase in the amount of cardiovascular autonomic reflex tests by 1 score and more. The unsatisfactory result of wound treatment was detected in patients with wound healing delay and new cases of surgery debridement, foot amputations and Charcot foot during 2 years of observation.Results. The mean duration of diabetes was 10.7 year, HbA1c 8.3%, LDL-Chol 3.3 mmol/l, TG 1.8 mmol/l. The 51.1% patients had been amputated in the level of foot, 48.9% patients had surgery debridement. All patients had CAN, confirmed/severe forms in 57.4% cases. The progression of CAN was found in 22.3% patients, the most of them with functional stage at baseline. The aggressive course of CAN increased the risk of progression of diabetic sensomotor neuropathy (OR = 14.6; 95% CI 3.0–70.5; p = 0.0006), nephropathy (OR = 22.4; 95% CI 3.4–147.4; p = 0.0009) and unsatisfactory result of wound treatment (OR = 40; 95% CI 6.0–268.5; p = 0.0001).Conclusions. The patients with diabetic foot surgery wounds has high risk of confirmed/severe CAN and its progression during 2 years. The aggressive course of CAN associates with unsatisfactory result of wound treatment and progression of microvascular diabetic complications.

Comparative analysis of laboratory data of 46 patients suffering from pneumonia caused by SARS-CoV-2 and 12 patients - pneumonia of bacterial etiology is given. It was established that in patients with COVID-19 compared to patients with bacterial pneumonia, the level of direct bilirubin is 84% more, and thrombocrit is three times more, which can indicate intravascular hemolysis and activation of the hemostasis system. Sex differences in laboratory indicators in patients with COVID-19, which go beyond the known limits of the physiological norm, were not detected. However, in men, hematocrit, hemoglobin, and plasma creatinine values were statistically higher than in women, but the amount of C-reactive protein in women was 5 times greater. However, these laboratory measures in COVID-19 have low prognostic significance. Therefore, conventional laboratory measures do not reveal clinic-critical differences in bacterial pneumonia and pneumonia caused by SARS-CoV-2. When conducting multifactorial analysis, it turned out that the laboratory indicators of patients suffering from bacterial pneumonia are not clustered and it is impossible to form predictor models from them. While laboratory indicators of patients suffering from pneumonia caused by COVID-19 form a directed pathogenetic response of the body as a whole, which causes multi-branch associated changes in homeostasis. Unfortunately, the amount of data available to us did not allow a qualitative discriminant analysis, which, with a very large amount of data, could lead to discriminant equations that are resistant to random emissions. This would allow, according to the available key individual laboratory indicators, to identify patients suffering from COVID-19 in the early stages already in the first hours of admission to the clinic.