ABSTRACT
Introduction. This article discusses the treatment of coronavirus infection (COVID-19) with glucocorticosteroid drugs (GCS), side effects of drugs and their prevention, transfer from intravenous to intramuscular and then to oral administration, and the development of withdrawal syndrome. The article describes the conditions under which antibiotic therapy is prescribed, as well as the conditions under which the combined use of corticosteroids and antibiotics is necessary. Aim. The aim to analyze the basic principles of corticosteroids prescribing in the treatment of COVID-19: indications for corticosteroids administration, administration regimens and required dosages, side effects of corticosteroids administration. Material and methods. The article uses data from the Interim Guidelines for the Prevention, Diagnosis and Treatment of New Coronavirus Infection (COVID-19), the Federal Clinical Guidelines for the Specialty "Rheumatology", as well as using the literature on basic and clinical endocrinology, cardiology and pharmacology. The work was written using a systems approach, methods of analysis, induction and observation. Results and discussion. Systemic corticosteroids are used in cases of severe and critical course of the disease COVID-19 (confirmation may be an increase in ferritin, procalcitonin, C-reactive protein (CRP), decreased cognitive functions, development of sopor). Their appointment is also justified when the initial course of the disease was not diagnosed as severe, but suddenly the patient's condition deteriorated. The use of antibiotic therapy is advisable when a bacterial infection is attached - (procalcitonin (PCT) > 0.5 ng / ml, purulent sputum, leukocytosis> 12 x 109 / L (in the absence of previous use of glucocorticoids), an increase in band neutrophils of more than 10%). In the presence of chronic infectious diseases in patients with COVID-19 (for example, chronic obstructive pulmonary disease-COPD, chronic pyelonephritis, etc.), antibiotics are prescribed to prevent exacerbations of these diseases. Conclusion. In the course of the study, the authors of the article formulated the following principles of glucocorticoid therapy: drugs should be prescribed according to strict indications;maximum doses are applied in a short course;when the patient's condition is stabilized, it is necessary to reduce the dose in a timely manner and gradually to complete withdrawal to prevent the development of "withdrawal" syndrome, adrenal insufficiency of central genesis, sympathoadrenal crises;during and after treatment, prevention of complications of glucocorticoid therapy (hyperglycemia, hypocalcemia, osteopenia, inflammatory diseases of the urinary system) is recommended;collegial management of patients by infectious diseases and endocrinologists is mandatory.
ABSTRACT
Introduction. This article discusses the treatment of coronavirus infection (COVID-19) with glucocorticoste-roid drugs (GCS), side effects of drugs and their prevention, transfer from intravenous to intramuscular and then to oral administration, and the development of withdrawal syndrome. The article describes the conditions under which antibiotic therapy is prescribed, as well as the conditions under which the combined use of corticosteroids and antibiotics is neces-sary. Aim. The aim to analyze the basic principles of corticosteroids prescribing in the treatment of COVID-19: indications for corticosteroids administration, administration regimens and required dosages, side effects of corticosteroids admin-istration. Material and methods. The article uses data from the Interim Guidelines for the Prevention, Diagnosis and Treatment of New Coronavirus Infection (COVID-19), the Federal Clinical Guidelines for the Specialty “Rheumatology”, as well as using the literature on basic and clinical endocrinology, cardiology and pharmacology. The work was written using a systems approach, methods of analysis, induction and observation. Results and discussion. Systemic cortico-steroids are used in cases of severe and critical course of the disease COVID-19 (confirmation may be an increase in ferritin, procalcitonin, C-reactive protein (CRP), decreased cognitive functions, development of sopor). Their appointment is also justified when the initial course of the disease was not diagnosed as severe, but suddenly the patient’s condition deteriorated. The use of antibiotic therapy is advisable when a bacterial infection is attached-(procalcitonin (PCT)> 0.5 ng/ml, purulent sputum, leukocytosis> 12 × 109/L (in the absence of previous use of glucocorticoids), an increase in band neutrophils of more than 10%). In the presence of chronic infectious diseases in patients with COVID-19 (for ex-ample, chronic obstructive pulmonary disease-COPD, chronic pyelonephritis, etc.), antibiotics are prescribed to prevent exacerbations of these diseases. Conclusion. In the course of the study, the authors of the article formulated the follow-ing principles of glucocorticoid therapy: drugs should be prescribed according to strict indications;maximum doses are applied in a short course;when the patient’s condition is stabilized, it is necessary to reduce the dose in a timely manner and gradually to complete withdrawal to prevent the development of “withdrawal” syndrome, adrenal insufficiency of cen-tral genesis, sympathoadrenal crises;during and after treatment, prevention of complications of glucocorticoid therapy (hyperglycemia, hypocalcemia, osteopenia, inflammatory diseases of the urinary system) is recommended;collegial management of patients by infectious diseases and endocrinologists is mandatory. © 2022, LLC "IMC" Modern Clinical Medicine. All rights reserved.
ABSTRACT
Background. More than half of those infected with the new coronavirus infection COVID-19 carry the disease in a mild or asymptomatic form. Patients over 60 years of age and those with comorbid chronic diseases, such as respiratory, cardiovascular, diabetes, oncological and autoimmune diseases, are susceptible to more severe forms of the disease. Aim. The aim of the study was to demonstrate the stages of clinical picture development, methods of diagnosis and treatment of the new coronavirus infection COVID-19. Material and methods. We present a clinical case of a new coronavirus infection COVID-19 in a 73-year-old patient with autoimmune polyglandular syndrome. Results and its discussion. Aggravating background represented by arrhythmic syndrome and autoimmune polyglandular syndrome contributed to the development of a severe form of new coronavirus infection COVID-19 in the patient. Complex multivector therapy aimed at pathogenetic and symptomatic treatment, according to the guidelines, in combination with magnesium and potassium medications, as well as immune-modulating therapy contributed to the patient’s recovery and rehabilitation. Conclusion. Treatment with glucocorticoids for new COVID-19 coronavirus infection significantly improves the outcome of the disease. At the same time, glucocorticoid therapy can lead to progression of arrhythmic syndrome, development of drug-induced hypercorticoidism, and «withdrawal» syndrome. Prevention and treatment of heart rhythm disturbances is the application of potassium and magnesium medications in sufficient doses. Gradual withdrawal of glucocorticoids over a long time under the supervision of an endocrinologist will help to restore the hypothalamic-pituitary-adrenal axis. © 2021, LLC "IMC" Modern Clinical Medicine. All rights reserved.
ABSTRACT
Background. The COVID-19 pandemic that emerged in China in late 2019 continues to be a global public health problem. The growing incidence of diabetes mellitus makes it necessary to assess the mutual impact of these two diseases on the patient prognosis. Aim. The aim of the study was to review the current information about the effect of SARS-CoV-2 virus on the course of diabetes mellitus and mortality, to consider the probability of developing newly diagnosed diabetes mellitus in patients who underwent COVID-19, and to analyze the possibilities of hypoglycemic therapy in the treatment of COVID-19 diabetic disease. Material and methods. Literature sources were searched in the PubMed database, using the keywords: COVID-19, SARS-CoV-2, and diabetes mellitus. The analysis included literature reviews, meta-analyses, systematic reviews, and clinical trials. Results and discussion. After reviewing about 9,000 sources of literature, 295 of the most relevant publications were analyzed, 60 of which were included in this paper. Insufficiently controlled diabetes mellitus appears to be independently associated with COVID-19 severity and high risk of death. Patients with severe COVID-19 in the background of diabetes mellitus are more susceptible to the damaging effects of the cytokine storm. Against the background of SARS-CoV-2 infection joining diabetes mellitus, decompensation of the disease with hyperglycemia occurs, which is difficult to correct even with insulin therapy. SARS-CoV-2 virus has the ability to bind to angiotensin-converting enzyme type 2 receptors that are expressed in β-cells, which can lead to rapid metabolic deterioration with the development of diabetic ketoacidosis or hyperglycemic hyperosmolar syndrome. There is a hypothesis of a potential link between SARS-CoV-2 infection and the development of newly diagnosed diabetes through a direct effect of the virus on pancreatic β-cells. Certain blood glucose-lowering drugs can be continued when infected with SARS-CoV-2 with a positive effect. Conclusions. More research is needed to determine the role of SARS-CoV-2 virus in the development of acute complications and manifestation of diabetes mellitus. Possibilities of modern hypoglycemic therapy of diabetes in COVID-19 are generally evaluated positively and require further study. © 2021, LLC "IMC" Modern Clinical Medicine. All rights reserved.