Nuclear factor erythroid 2-related factor 2 (Nrf2) and heme oxygenase-1 (HO-1) have significant roles in the development of a hyperinflammatory state in infectious diseases. We aimed to investigate the association of the serum concentrations of Nrf2 and HO-1 with the severity of COVID-19 disease. The study included 40 subjects with mild and moderately severe forms of the disease (MEWS scoring system ≤2). Twenty of the subjects had MEWS scores of 3 or 4, which indicate a severe form of the disease, and twenty subjects had a MEWS score of ≥5, which indicates a critical form of the disease. HO-1 and Nrf2 were measured using the commercially available Enzyme-Linked Immunosorbent Assay (ELISA). Subjects with the most severe form of COVID-19 (critically ill) had a lower concentration of Nrf2 that negatively correlated with the markers of hyperinflammatory response (CRP, IL-6, ferritin). This observation was not made for HO-1, and the correlation between Nrf2 and HO-1 values was not established. In the mild/moderate form of COVID-19 disease, Nrf2 was associated with an increased 1,25 dihydroxy vitamin D concentration. The results of this study show that Nrf2 has a role in the body’s anti-inflammatory response to COVID-19 disease, which makes it a potential therapeutic target.

Visceral adipose tissue is an independent risk factor for the development of atherosclerotic coronary disease, arterial hypertension, diabetes and metabolic syndrome. Right heart morphology often involves the presence of adipose tissue, which can be quantified by non-invasive imaging methods. The last decade brought a wealth of new insights into the function and morphology of adipose tissue, with great emphasis on its role in the pathogenesis of heart disease. Cardiac adipose tissue is involved in thermogenesis, mechanical protection of the heart and energy storage. However, it can also be an endocrine organ that synthesises numerous pro-inflammatory and anti-inflammatory cytokines, the effect of which is accomplished by paracrine and vasocrine mechanisms. Visceral adipose tissue has several compartments that differ in their embryological origin and vascularisation. Deficiency of cardiac adipose tissue, often due to chronic pathological conditions such as oncological diseases or chronic infectious diseases, predicts increased mortality and morbidity. To date, knowledge about the influence of visceral adipose tissue on cardiac morphology is limited, especially the effect on the morphology of the right heart in a state of excess or deficient visceral adipose tissue.

Based on the clinical experience, it has been observed that when it comes to the impact of SARS-CoV-2 virus on the cardiovascular system, it is significant. In patients with COVID-19 infection, the development of myocarditis occurs a few days after the onset of fever. The mechanism of myocardial injury alone, as well as most pathologies caused by the SARS-CoV-2 virus, is the subject of research by many experts, but two basic ways can certainly be assumed: a direct toxic effect of SARS-CoV-2 on myocardial cells and another possible way of myocardial injury is to activate the innate immune response by releasing proinflammatory cytokines, as well as to activate the adaptive mechanisms of the autoimmune type by molecular mimicry. The approach to treatment is the same as for other viral myocarditis; it is non-specific, applied supportive treatment, such as anti-inflammatory drugs, low-dose corticosteroid therapy, and immunoglobulins. The aim of this review is to present the previous experiences of physicians around the world on the clinical presentation of myocarditis caused by COVID-19 infection, diagnostic and therapeutic approach in a specific situation of high-risk infection.

Lemierre's syndrome refers to the septic thrombophlebitis of the internal jugular vein. The condition typically begins with an oropharyngeal infection and frequently involves inflammation within the wall of the vein, infected thrombus within the lumen, surrounding soft tissue inflammation, persistent bacteremia, and septic emboli. Lemierre's syndrome is a rare disease; it occurs most commonly in otherwise healthy young adults. The most common etiologic agent is Fusobacterium necrophorum. We present a case of Lemierre's syndrome in a young girl and the role of extracorporeal method of blood purification with continuous venous hemodiafiltration with the use of a highly adsorptive membrane (AN69 HeprAN), thus achieving the combined elimination of cytokines and endotoxins. The use of advanced methods, along with an antibiotic and surgical treatment, will certainly help reduce mortality in this syndrome.

Aim: The outbreak of novel coronavirus pneumonia that was first detected in Wuhan in December 2019 resulted in a worldwide pandemic. Approximately 25% of confirmed cases developed a severe disease and the need for intensive care unit admission. The aim of this study was to determine the role of three inflammatory scoring systems, C-reactive protein/albumin ratio, fibrinogen/albumin ratio, C-reactive protein/lymphocyte ratio and their association with survival, comorbidities, and the occurrence of additional complications in the intensive care of these patients. Materials and methods: This retrospective study was conducted based on data collected by the Department of Respiratory Center. Ethical approval for the study was obtained from the Ethics Committee of Osijek University Hospital. This study analysed data retrospectively between October and December 2020, and included 137 critically ill patients with a diagnosis of COVID-19. Results: Data analysis of three examined inflammatory points of the system, below and above the median found a significant association in the group below the median C-reactive protein/albumin ratio with the presence of complications (p= 0,039) in the group above the median in the study of fibrinogen/albumin ratio found a significant association with sepsis (p=0,043). In the group of participants who were above its median in terms of C-reactive protein/lymphocyte ratio, there were more of those with the development of acute kidney injury (p=0,014), and sepsis (p=0,009). Conclusion: Inflammatory scoring systems, C-reactive protein/albumin ratio, fibrinogen/albumin ratio and C‐reactive protein/lymphocyte ratio represent an independent prognostic indicator of the clinical course in critically ill patients with COVID-19 infection.