ABSTRACT
The aim of our study was to assess the ventilation function of the lungs in persons who had pneumonia after COVID-19 in the Pridneprovie region in January-April 2021, and to determine the types of ventilation disorders and their severity. We examined 41 people who had pneumonia after COVID-19 not earlier than 4 weeks after the onset of clinical symptoms (the median is 48 (40;68) days). All of them made up the main group (average age - 55.8 +/- 5.6 years, men - 21 (51.2%), women - 20 (48.8%)). Patients were divided into two subgroups depending on the severity of the coronavirus disease in the acute period: subgroup 1 included 26 people (average age - 56.1 +/- 4.2 years;men - 12 (42.2%), women - 14 (53.8%)) who had a mild course of the acute period of the disease;subgroup 2 - 15 people (average age - 55.2 +/- 5.3 years, men - 9 (60.0%), women - 6 (40.0%)), who had a severe course of the acute period of COVID-19. Clinical examination, assessment of dyspnea (The Modified Medical Research Council Dyspnea scale), level of the cough and sputum (by the Savchenko scale), oxygen saturation, spirometry with a bronchodilation test were conducted. Almost half of the patients with pneumonia after COVID-19 had various disorders of the ventilation function of the lungs. In cases with a mild course of the acute period of COVID-19, obstructive changes were significantly more frequent (p=0.035), and in patients with a severe course of the acute period of COVID-19 - restrictive disorders (p=0.002) prevailed. Bronchoobstructive changes in the post-COVID period are most often caused not by decrease in the forced expiratory volume per second but by the ratio of (FEV1)/forced vital capacity (below 0.7) and/or by the presence of visualized changes in the "flow-volume" curve.
ABSTRACT
The search for clinical and laboratory markers of COVID-19-associated CAP progression is an urgent problem of today. The aim of our study was to determine the risk factors for the burden of the pathological process by establishing the diagnostic and prognostic significance of clinical and hemocoagulation parameters in the hospital stage of management of patients with CAP on the background of coronavirus disease (COVID-19). The study included 53 individuals of the main group. All patients were examined twice: on the first day of hospitalization (visit 1) and in the dynamics (7-10 days after hospitalization (visit 2)). In 30 (83.3%) patients of subgroup 1, despite adequate treatment, there was an increase in breathing rate and a decrease in saturation to severe (less than 92%) or critical (less than 85%) levels (in 28 and 2 cases respectively). In subgroup 2, the progression of respiratory failure to a critical level was observed in 5 of 12 (41.7%) patients. Conclusions: at the stage of hospitalization of patients with COVID-19-associated CAP the most sensitive clinical predictor of aggravation of the patient's condition is tachypnea of 20 or more;laboratory - the level of D-dimer 200 ng/ml, which increases the risk of progression of the pathological process by 16 times.
ABSTRACT
Continuing education in terms of improving the professional competence of doctors has a great importance. In May 2020 for the first time in Ukraine under conditions of quarantine connected with COVID-19 the Prydniprovsk Association of Internal Medicine Doctors organized a 2-day international conference on internal medicine in a web format. The purpose of the work was to organize, conduct, determine the effectiveness of the international conference of internists in online format and analyze the results of the survey of students. A questionnaire which included 28 test tasks was developed by the lecturers to obtain a feedback. The answers were analyzed and the reasons for possible errors were considered. The level of knowledge acquired by students is generally quite high;however, the most problematic issues were the most modern diagnostic methods in gastroenterology, ECG diagnostics, clinical pharmacology in cardiology and pulmonology. The prospect of developing a system of continuing professional education for internists is to improve teaching methods with the subsequent involvement of leading specialists in various therapeutic areas to cover current issues of medical science and practice. © 2021 Editorial Department of Scientia Agricultura Sinica. All rights reserved.
ABSTRACT
The diagnosis of community-acquired pneumonia (CAP) on the background of COVID-19 is especially actual due to the prevalence of this pathology and the possible aggravation of the pathological process. The aim of our study was to improve the principles of CAP diagnostics on the background of COVID-19 and to determine risk factors for aggravating of the pathological process. Patients with respiratory symptoms who were hospitalized with suspected COVID-19 were examined. General clinical research methods were carried out, determination of SARS-CoV-2 virus RNA by PCR method, computer tomography (CT) to identify the features of lung tissue damage was performed. The main observation group consisted of 37 patients (men-19 (51.4%), average age-61 (57;69) years) with pneumonia on the background of confirmed COVID-19. According to the severity of coronavirus disease, all patients of the main group were divided into 3 subgroups: subgroup 1 included 17 people with moderate COVID-19, subgroup 2-13 people with severe COVID-19, subgroup 3-7 people with critical COVID-19 course. The levels of markers of systemic inflammation (C-reactive protein (C-RP) and fibrinogen) were also determined. Since patients with COVID-19 of moderate severity (which is characterized by the presence of community-acquired viral pneumonia) belong to the risk group of severe and critical course, it is suggested to consider the following risk factors for aggravating the pathological process as: temperature over 38.5 degrees C, heart rate over 90 per minute, respiratory rate over 20 per minute, SpO(2) <= 93%;absolute lymphopenia (less than 0.9 G/L) and an increase in serum levels of C-RP more than 50 mg/L and fibrinogen more than 5 g/L.