ABSTRACT
BACKGROUND. The presence and drug correction of arterial hypertension (AH) with inhibitors of the renin-angiotensin system (RAS), as well as chronic kidney disease (CKD) and its role in the regulation of RAS, can significantly affect the condition of a person with COVID-19. OBJECTIVE: to study the features of the functional state of the kidneys in patients with grade 1-2 hypertension who have fallen ill with COVID-19. PATIENTS AND METHODS. A subanalysis of patients with CKD, participants in the BIRCOV study (ARB, ACEi, DRi in COVID-19) is presented: 112 outpatient patients with grade 1-2 hypertension, 83 of whom had CKD. The participants were divided into groups receiving ACE inhibitors (group 1 - 39 %), ARBs (group 2 - 32 %), or a direct renin inhibitor (PIR) (group 3 - 29 %) as the main therapy of hypertension. The value of blood pressure, eGFR, albuminuria level were analyzed at the debut of COVID-19 and at 2, 4, 12, 24 weeks from the onset of the disease. RESULTS. In the first two weeks of COVID-19, there was a decrease in blood pressure with a gradual return to baseline values in patients of group 1 and group 3 (to a lesser extent). The use of ACE inhibitors in the treatment of hypertension increased the risk of withdrawal compared to PIR and ARBs due to COVID-19. In patients with CKD, higher values of mean blood pressure were obtained with similar dynamics. A synchronous decrease in eGFR and systolic blood pressure has been documented, more pronounced in patients with CKD, especially when taking aCEI. The decrease in eGFR correlated with the stage of CKD. With stable renal function in patients with CKD during the first 12 weeks of COVID-19, the urine albumin/creatinine ratio (UAC) increased without further normalization. By the second week of the disease, eGFR decreased with a reciprocal increase in the level of uric acid in the blood. The use of dexamethasone was accompanied by a decrease in eGFR in CKD stages 3b-4. CONCLUSION. When taking ACE inhibitors, the effect of lowering blood pressure was comparable to a double block of RAS: ACE inhibitors + ARBs. © 2022 Educational Autonomous Non-Profit Organization Nephrology. All right reserved.
ABSTRACT
Background. One of the symptoms of COVID-19 is the so-called "cytokine storm". Its pathogenesis is that the initial release by lymphocytes and macrophages of proinflammatory cytokines in the classical immune response to SARS-CoV-2 is significantly enhanced and maintained due to excessive adrenergic stimulation of the immune cells. The proinflammatory adrenergic mechanism of the "cytokine storm" can be offset by the activation of the anti-inflammatory cholinergic mechanism by non-invasive stimulation of the vagus nerve. In 2015, a generator for electrotherapy and stimulation oh human nerve centers was created, called "VEB-1"(R). Preliminary observation of volunteers revealed a modulating effect of a four-day course of electrical stimulation on the parameters of electroencephalogram, metabolism, as well as gas-discharge visualization (GDV). We hypothesized that changes in EEG parameters may be accompanied by a vagotonic shift of the sympatho-vagus balance, favorable for calming the "cytokine storm". The main purpose of this study was to find out. In addition, concomitant changes in EEG, immunity, GDV, etc. due to the use of the devices "VEB-1" (R) and recently designed "VEB-2" had to be detected. Material and research methods. The object of observation were 18 volunteers: 11 women 33-62 y and 7 men 29-62 y (Mean +/- SD: 51 +/- 12 y) without clinical diagnose but with dysfunction of neuro-endocrine-immune complex and metabolism. In the morning registered HRV ("CardioLab+HRV", "KhAI-Medica", Kharkiv, UA), EEG ("NeuroCom Standard", "KhAI-Medica", Kharkiv, UA), kirlianogram by the method of GDV ("GDV Chamber", "Biotechprogress", SPb, RF), electroconductivity of skin in three pairs of points of acupuncture ("Medissa"), electrokinetic index of buccal epithelium ("Biotest", Kharkiv State University), as well as some parameters of immunity and metabolism. After the initial testing, an electrical stimulation session was performed with a "VEB-1"(R) or a "VEB-2" devices. The next morning after completing the four-day course, retesting was performed. Results. The effects of electrical stimulation can be divided into the following networks. Regarding EEG, this is a leveling of right-hand lateralization and normalizing decrease in the increased of the amplitude of the theta-rhythm and its spectral power density (SPD) at the loci F3, F7, F8, T3, T4, T6, P3, O1 and O2;further increase of SPD of d-rhythm in loci F3, F4, T6, P3 and O1 as well as further decrease of SPD F4-a;reversion of the increased level of entropy in loci Fp1, F4, C3 and P3 to the lowered level. Regarding HRV, it is a vagotonic shift of sympatho-vagus balance due to a decrease in elevated levels of sympathetic tone markers and an increase in decreased levels of vagus tone markers, but without normalization. Neurotropic effects are accompanied by favorable changes in a number of immune parameters and a tendency to decrease the level of C-Reactive Protein. Regarding GDV, it is almost complete normalization of the initially increased GDI Area in the frontal projection and third Chakra Energy;normalizing decrease in the initially increased Energy of second and seventh Chakras;normalizing right-hand shift of more or less pronounced left-sided Asymmetry of first and third Chakra. These effects should be clearly interpreted as physiologically beneficial. The effects on these parameters are almost equally pronounced in people of both sexes when using both devices. Conclusion. Vagotonic and immunotropic effects of our device give us a reason to offer it for further research on the leveling of "cytokine storm" in patients with COVID-19.
ABSTRACT
During pandemic coronavirus disease (COVID-19) a number of problems emerged concerning specific diagnostics and possible development of etiotropic and pathogenic treatment. At the same time, common etiopathogenic mechanisms are known to have a special place in occurrence and development of acute respiratory diseases. The studies carried out in the Laboratory of Experimental and Clinical Pathology, the state enterprise “Ukrainian Scientific-Research Institute of Transport Medicine, the Ministry of Health of Ukraine” (V.P. Divocha, 1989-2012), are indicative of that the character of interaction between flu virus and the human body much depends on the state of proteinase-inhibitor body system, playing a considerable role in damaging respiratory tract tissues and development of inflammations. It gives grounds to suppose that effect produced on the proteinase-inhibitor system can be an important way of pathogenic therapy of the disease, and inductors of inhibitor synthesis can be used for prevention and treatment of flu by means of modulation of the human protective mechanisms (1-6). The paper deals with an alternative pathogenic approach to prevention and treatment of flu and acute respiratory viral infections (ARVI) based on the application of polarized, polychromatic, linear, incoherent, low-energy light (PILER-light) (Guliar S.О., Lymanskyi Yu.P., 2003), which does not contain ultraviolet and a considerable amount of infrared rays (7-12).