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Background: UMHATEM N.I. Pirogov" Sofia, is one of the largest and busiest hospitals for emergency medical care in Bulgaria. It is the legal successor of the former Institute of Emergency Medicine N.I. Pirogov", and it can be said that at the moment it is the only diagnostic-therapeutic, prophylactic and scientific-educational structure of this type within the Bulgarian healthcare system. The concept of adequate functioning and development of this type of hospital does not consider structuring an Infectious Diseases diagnostic-treatment unit. This reality makes necessary the formation of a radically different organization for the admission and treatment of patients in the hospital, both for those with symptoms of Covid 19 and for all other emergency patients. The organization created in this way must absolutely guarantee safety for both streams of patients. In the conditions of a pandemic, in case of a real threat to public health, the main task of triage in the Emergency Department is to establish indications for urgent hospitalization, or to refuse it in the absence of indications. The characteristic course of the disease, the prolonged treatment, the manifestations within the so-called post-Covid syndrome", require serious planning not only of the diagnostic-treatment and rehabilitation period, but also adequate monitoring in the first months after the patient's discharge. Within the national reorganization measures, during the determined periods, the main changes concerning the MED (Multi-profile emergency department) of Pirogov are implemented, with an emphasis on the formation of a specialized triage for the diagnosis and clinical evaluation of patients with a coronavirus infection. The main goal is the adequate diagnosis, treatment and follow-up of patients with coronavirus infection who have passed through the organized Covid-triage in a period of extreme pressure on the emergency structures and on the hospital system in the country as a whole. Objective(s): For a MED, which at the time of declaring an epidemic situation does not have a concept for the diagnosis and treatment of infectious diseases, to systematize the main urgently implemented organizational and structural changes, which turned out to be absolutely necessary to meet a newly emerging epidemiologically significant infectious disease. Aim(s): To systematize the organizational changes imposed by the situation and urgently implemented in the MED (multi-profile emergency department). To systematize the structural changes imposed by the situation and urgently implemented in the work of the MED. To analyze the organizational and structural changes carried out in this way and to differentiate the main difficulties caused by the regulations existing at the time of the announcement of the epidemic situationCopyright © Pantileeva D et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC-BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited
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The aim of current study was to determine, retrospectively, possible correlations between smoking and the incidence, course severity, intubation rate, and mortality (by gender and age) in patients treated for complicated coronavirus infection in the internal medicine clinic at UMHATEM ”N. I. Pirogov” Sofia for the period 01.03.2020–31.12.2020. In a prospective study, the recovery period and immunogenesis in smokers and non-smokers within a one-year period after hospital discharge was investigated. The applied methods were: 1) computed tomography and blood gas analysis 2) chemiluminescent immunoassay for the qualitative determination of total IgM, IgA and IgG anti-SARS-CoV2 AB. Results showed that the part of non-smokers with a positive PCR test is significantly higher compared to the group of former and current smokers. The data obtained from the study confirmed that Covid infection is much more severe among smokers and former smokers with a higher levels of inflammatory markers noticed among the smoking group.
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The aim of the work was to summarize the experience of the Rostov-on-Don Research Anti-Plague Institute in the organizational and functional response aimed at ensuring the implementation of a complex of on-going and scheduled anti-epidemic (preventive) measures at different territorial levels in the context of COVID-19 pandemic. Stage-wise reassignment of scientific and operational subdivisions of the facility was carried out in a timely manner in a flexible mode for a prompt response to the challenges that arose from community transmission of the new coronavirus infection in the territory of the Russian Federation. It allowed an effective distribution of the forces and assets without damage for specialized functioning in the main areas of scientific and practical activities. Realized was an effective interdepartmental interaction with territorial scientific and practical institutions of the Rospotrebnadzor and specialized medical organizations. Practical, methodological and advisory assistance was provided to personnel of specialized medical institutions within the framework of conversing in-patient facilities into hospitals for the treatment of patients with COVID-19. Priority research to study the level of the humoral and cellular immune response to SARS-CoV-2 among the population of the Rostov Region, the etiological spectrum of the causative agents of community-acquired pneumonia associated with COVID-19, full genome sequencing of SARS-CoV-2 isolates was carried out. Specialists of the task forces reinforced human resources of individual laboratory facilities in Moscow city, the Republic of Crimea and the Rostov Region. Complex objective of effective functioning has been implemented: in an operational mode – participation in anti-epidemic (preventive) measures in the face of changes in the dynamics and intensity of the epidemic manifestations of new coronavirus infection;in scheduled mode – the implementation of activities in the main areas of the scientific work of the organization. © 2022 Russian Research Anti-Plague Institute. All rights reserved.
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The present research aims to ascertain the views of the people in Russia, about their levels of awareness in terms of hygiene and personal care for protection against the coronavirus. Data for this research were collected through an online questionnaire developed by researchers using a quantitative research approach. A total of 439 people living in different districts of the Russian Federation were involved to the research based on simple random sampling. The data were analyzed using descriptive statistics including frequencies and percentages. Results revealed that the participants paid attention to not having close contact with other people to protect themselves against the COVID-19 pandemic. The findings also revealed that they wash their hands after visiting the toilet and stand one meter away from other people. It was also found that television is the mass medium through which they follow the information on personal care and hygiene-related to the COVID-19 pandemic most frequently. © 2022. by the authors;licensee Modestum. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/)
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The results of a one-year prospective study, during which the process of immunogenesis in patients over 18 years of age with moderate and severe coronavirus infection was monitored and analyzed in clinical and paraclinical (clinical laboratory) aspects, are summarized and presented. The study included 2683 patients, all treated in the Clinic of Internal Diseases at the University Multiprofile Hospital for Active Treatment and Emergency Medicine “N. I. Pirogov” EAD, Sofia for the period from April 2020 to December 2020. Patients were followed for one year after recovering from moderate to severe coronavirus infection. Patients are grouped into four age categories as follows: 18–45 years;46–65 years;66–80 years and over 80 years. The results of our study show that during the study period in 97% of patients the level of anti-SARS-CoV2, rose and in the remaining three percent it was flat or followed by subsequent waning (in less than 1% of patients), but does not reach critically low levels (i. e. below the positivity conditional threshold). The level of IgG reached a peak and then waned, but on the other hand, as mentioned above, the amount of Ig-Total tested shows a significant increase. This trend is observed in all age groups, with a difference in the level of IgG and Ig-Total depending on age. The results of the additional screening in the target period in terms of virulence and virus segregation, categorically rule out the suspicion of the presence of “silent spreader”. During the follow-up period, no patients were re-hospitalized due to recurrence of Coronavirus infection (re-infection and illness). © 2022
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The international AKTIV register presents a detailed description of out-and inpatients with COVID-19 in the Eurasian region. It was found that hospitalized patients had more comorbidities. In addition, these patients were older and there were more men than among outpatients. Among the traditional risk factors, obesity and hypertension had a significant negative effect on prognosis, which was more significant for patients 60 years of age and older. Among comorbidities, CVDs had the maximum negative effect on prognosis, and this effect was more significant for patients 60 years of age and older. Among other comorbidities, type 2 and 1 diabetes, chronic kidney disease, chronic obstructive pulmonary disease, cancer and anemia had a negative impact on the prognosis. This effect was also more significant (with the exception of type 1 diabetes) for patients 60 years and older. The death risk in patients with COVID-19 depended on the severity and type of multimorbidity. Clusters of diseases typical for deceased patients were identified and their impact on prognosis was determined. The most unfavorable was a cluster of 4 diseases, including hypertension, coronary artery disease, heart failure, and diabetes mellitus. The data obtained should be taken into account when planning measures for prevention (vaccination priority groups), treatment and rehabilitation of COVID-19 survivors.
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The organizer of the registers “Dynamics analysis of comorbidities in SARS-CoV-2 survivors” (AKTIV) and “Analysis of hospitalizations of comorbid patients infected during the second wave of SARS-CoV-2 outbreak” (AKTIV 2) is the Eurasian Association of Therapists (EAT). Currently, there are no clinical registries in the Eurasian region designed to collect and analyze information on long-term outcomes of COVID-19 survivors with comorbid conditions. The aim of the register is to assess the impact of a novel coronavirus infection on long-term course of chronic non-communicable diseases 3, 6, 12 months after recovery, as well as to obtain information on the effect of comorbidity on the severity of COVID-19. Analysis of hospitalized patients of a possible second wave is planned for register “AKTIV 2”. To achieve this goal, the register will include men and women over 18 years of age diagnosed with COVID-19 who are treated in a hospital or in outpatient basis. The register includes 25 centers in 5 federal districts of the Russian Federation, centers in the Republic of Armenia, the Republic of Kazakhstan, the Republic of Kyrgyzstan, the Republic of Belarus, the Republic of Moldova, and the Republic of Uzbekistan. The estimated capacity of the register is 5400 patients.
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The etiological cause of Coronavirus infection, which has captured the attention of almost the whole world at the moment, is SARS-CoV2. The clinical picture of coronavirus infection varies from asymptomatic to severe respiratory infection with manifestations of respiratory failure, the development of respiratory distress syndrome and even death. Already in the first months of the coronavirus pandemic in the United States there was a serious decline in the number of patients seeking medical care in the Emergency Department (49.3%) compared to 2019. There is evidence of increased mortality during the pandemic, which causality cannot be directly or associated with coronavirus infection. Even in the context of a global pandemic, we must not forget all other diagnoses and conditions that exist as comorbidity, and emergency care must be provided without delay and delay.
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The possibilities for pharmaceutical care in the recovery of patients with post-COVID syndrome in the context of a patient-centered approach have been explored. The global COVID-19 pandemic has necessitated a reorientation of the concept of providing health- care to patients with COVID and post-COVID syndrome in patient-centered treatment and rehabilitation. Maximum recovery in holistic practice adopts a broader view of the patient’s health, disease and treatment process. Applying a patient-centered approach to patients who have had a coronavirus infection will lead to many benefits, both in terms of the quality of health and pharmaceutical care, and in increasing their satisfaction with their quality of life.
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The assessment of changes in the level of cognitive functions in patients who underwent COVID-19 was carried out. The analysis of more than 30 modern scientific studies for 2019-2021 showed that patients who had the new coronavirus infection of varying severity, there are significant changes in the level of cognitive functioning in the form of a decrease in memory, executive functions, attention, etc.
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The mobile complexes of the specialized anti-epidemic teams (SAET) of the Rospotrebnadzor (mounted on the platform of auto chassis) have been actively involved in implementation of operational measures to counter COVID-19 in the Russian Federation, aimed at management and conducting of diagnostic studies. Analysis of the activities of mobile SAET in Moscow and Makhachkala made it possible to formulate the basic principles of organizing their work in the most difficult period of negative development of the situation, increasing incidence and insufficient readiness of laboratory bases for mass research: tactics of advance actions, flexibility in using the potential of SAET mobile complexes, monitoring over the implementation of anti-contamination measures at all stages of PCR analysis and the development of a consultative and methodological (training) aspects of activities of the team specialists. The use of mobile SAETs of the Rospotrebnadzor once again demonstrated their significance as a universal tool to counter epidemics of infectious diseases. © 2020 Russian Research Anti-Plague Institute. All rights reserved.
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COVID-19 is a severe infection with high mortality. The concept of the disease has been shaped to a greater extent on the basis of large registers from the USA, Spain, Italy, and China. However, there is no information on the disease characteristics in Caucasian patients. Therefore, we created an international register with the estimated capacity of 5,000 patients - Dynamics Analysis of Comorbidities in SARS-CoV-2 Survivors (AKTIV SARS-CoV-2), which brought together professionals from the Russian Federation, Republic of Armenia, Republic of Kazakhstan, and Kyrgyz Republic. The article presents the first analysis of the register involving 1,003 patients. It was shown that the most significant difference of the Caucasian population was the higher effect of multimorbidity on the mortality risk vs other registers. More pronounced effect on mortality of such diseases as diabetes, obesity, hypertension, chronic kidney disease, and age over 60 years was also revealed. COVID-19 - тяжелое инфекционное заболевание с высоким риском летального исхода. Представление о болезни во многом сформировано на основании крупных регистров, выполненных в США, Испании, Италии, КНР. Однако к настоящему времени нет данных по особенностям протекания болезни у пациентов евроазиатского региона. В связи с этим был создан международный регистр, расчетная мощность которого составляет 5000 пациентов, “Анализ динамики Коморбидных заболеваний у пациенТов, перенесшИх инфицироВание SARS-CoV-2” (AКТИВ SARS-CoV-2), работа в котором объединила специалистов Российской Федерации, Республики Армения, Республики Казахстан и Кыргызской Республики. В статье представлен первый анализ регистра, который включил данные 1003 пациентов. Показано, что самым значимым отличием евроазиатской популяции пациентов оказалось гораздо большее влияние полиморбидности на риск летального исхода в сравнении с другими регистрами, а также более выраженное влияние на риск летального исхода в евроазиатской популяции таких заболеваний, как сахарный диабет, ожирение, артериальная гипертензия, хроническая болезнь почек и возраста старше 60 лет.
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The new pandemic disease COVID is quick spread worldwide.The primary method used for diagnosing of COVID-19 is detecting viral nucleic acids. The main problem with RT-PCR test is the false negative results. The negative RT-PCR does not exclude a SARS-CoV-2 infection and this method should not be used as the only diagnostic criteria. The RT-PCR result does not change the complex treatment of the disease. The aim of the current study is to compare the four groups clinical cases of the different parameters: RT-PCR test, rapid test, clinical picture, laboratory tests as hematology, inflammatory markers, coagulation status and chemistry and imaging examinations: Chest X-ray at and Chest CT scan. Complex therapeutic approach has been implemented: antibiotic, inflammatory, anticoagulants, oxygen therapy, hepatoprotectors, antimycotics, fibrinolytics, probiotics, essential oils, vitamins. During the follow-up period, a tendency for significant reduction and resorption of the pulmonary changes on the CT scans has been seen.
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The aim of current study was the investigation of complex treatment including nutritional supplement with recognized antioxidant and immunomodulatory properties (malic, glycyrrhizic, ascorbic and folic acids, glucosamine, arginine, glycine, calcium pantothenate, cyanocobalamine, zinc sulfate, pyridoxal) and purely plant systemic protease supplement (Serrapeptase, Bromelaim, Boswellia, Uncaria tomentosa, Quercetin) as a strategy against Covid 19. A clinical case of a 33-year-old patient treated in Internal Clinic Diseases "Pirogov" against atypical bilaterally viral pneumonia with RT-PCR proven coronavirus have been presented. A complex treatment strategy was applied: Doxycycline, Amikacin sulfate, food additive containing malic and glycyrhizic acids, aminoacids, B-vitamins, antioxidants, proteolytic agent, Methylprednisolone, anticoagulant: Nadroparin calcium, hepatoprotector: Ademethionine. After 16 days hospitalization and two negative RT-PCR tests the patient was discharged in improved condition and home treatment with Levofloxacin hemihydrate, vitamins, probiotics, immunomodulatory and proteolytic products for one month was recommended. Immunostimulating, proteolytic and other products have an important role in complex treatment.