The Problem of Comorbid Socially Significant Infections Under The Conditions of The COVID-19 Pandemic.

The aim of the study. To analyze formation features of the epidemic situation for tuberculosis (TB) in the context of the COVID-19 pandemic in order to predict the further actions of medical organizations. Materials and methods. The data for the region for the last 5 years (2017-2021) were analyzed, including 1,762 newly diagnosed cases of patients with TB and comorbidities (according to the data of the Regional Public Health Organization <<Regional Clinical Anti-Tuberculosis Dispensary>>). All cases were verified using standard diagnostic methods, including molecular genetic methods, to determine the resistance of pathogens to antibacterial drugs. Results. It was revealed that the epidemiological situation in the region was multidirectional: thus, during the COVID-19 epidemic, the most pronounced incidence decrease was observed among cases of chronic course hepatitis (by 16.4 times), while among patients with tuberculosis the incidence decreased by 2.75 times, and among patients with acute hepatitis - only by 1.5 times (P<0.05). Among the cases of comorbid infection, the most severe course was observed in patients with combined (TB + HIV) infection: there was both a more severe general condition, and the development of adverse (undesirable) reactions to anti-TB drugs, which required an extension of maintenance therapy. Conclusions. The results of the study showed that against the background of the COVID-19 pandemic in the region, there was no tendency towards a worsening of the epidemic situation, primarily for the more socially significant infection - tuberculosis. At the same time, there was an increase in the number of cases of comorbid pathology, including HIV + TB. In the treatment of patients with comorbid forms of infection, it is necessary to take into account the possibility of developing hepatotoxic reactions and, as a result, the appointment of accompanying drugs with hepatoprotective and detoxification effects in therapy.Copyright © Team of Authors, 2022.

The Problem of Comorbid Socially Significant Infections Under The Conditions of The COVID-19 Pandemic

The aim of the study. To analyze formation features of the epidemic situation for tuberculosis (TB) in the context of the COVID-19 pandemic in order to predict the further actions of medical organizations. Materials and methods. The data for the region for the last 5 years (2017-2021) were analyzed, including 1,762 newly diagnosed cases of patients with TB and comorbidities (according to the data of the Regional Public Health Organization «Regional Clinical Anti-Tuberculosis Dispensary»). All cases were verified using standard diagnostic methods, including molecular genetic methods, to determine the resistance of pathogens to antibacterial drugs. Results. It was revealed that the epidemiological situation in the region was multidirectional: thus, during the COVID-19 epidemic, the most pronounced incidence decrease was observed among cases of chronic course hepatitis (by 16.4 times), while among patients with tuberculosis the incidence decreased by 2.75 times, and among patients with acute hepatitis - only by 1.5 times (P<0.05). Among the cases of comorbid infection, the most severe course was observed in patients with combined (TB + HIV) infection: there was both a more severe general condition, and the development of adverse (undesirable) reactions to anti-TB drugs, which required an extension of maintenance therapy. Conclusions. The results of the study showed that against the background of the COVID-19 pandemic in the region, there was no tendency towards a worsening of the epidemic situation, primarily for the more socially significant infection - tuberculosis. At the same time, there was an increase in the number of cases of comorbid pathology, including HIV + TB. In the treatment of patients with comorbid forms of infection, it is necessary to take into account the possibility of developing hepatotoxic reactions and, as a result, the appointment of accompanying drugs with hepatoprotective and detoxification effects in therapy.

INCLUSION OF REAMBERIN INTO COMPREHENSIVE OUTPATIENT REHABILITATION SCHEME FOR PATIENTS WITH SARS-CoV-2 ASSOCIATED PNEUMONIA

Effectiveness of the inclusion of reamberin in the complex rehabilitation of patients suffering of pneumonia caused by SARS-CoV-2 was evaluated at the outpatient stage. The data of 162 patients who received the rehabilitation treatment including, in addition to pharmacological benefits, exercise therapy and vacuum labile massage, were analyzed. In addition, patients of the main group (n = 82) received reamberin (1.5%, intravenously in a volume of 500 mL) for 10 days. The biochemical parameters of blood were studied in dynamics, and the blood oxygenation was monitored by the Stange and Genchi tests and the pulse oximetry. The quality of life was assessed in terms of the SF-36 questionnaire. The inclusion of reamberin in the complex rehabilitation contributed to improvement of the main biochemical parameters of blood (the levels of aspartate aminotransferase, alanine aminotransferase, and gamma-glutamyl transpeptidase decreased 1.2, 1.7, and 1.9 times, respectively, p0.5) and caused a more pronounced increase in the external respiration function (on the average by 8.4 sec according to the Stange test and by 9.1 sec according to the Genchi test), which was accompanied by positive trends in the quality of life indicators (according to the SF-36 questionnaire) in terms of physical functioning (by 5.1 points) and general health status (by 3.76 points. The obtained clinical and laboratory data, together with good tolerance of the drug, allow us to recommend the inclusion of reamberin in rehabilitation regimens for patients with pneumonia caused by SARS-CoV-2. Copyright © 2022 Izdatel'stvo Meditsina. All rights reserved.

Medical Rehabilitation of Elderly and Senior Patients with COVID-19-Associated Pneumonia

The aim of the study was to evaluate the effectiveness of including remaxol in the medical rehabilitation of elderly and senior patients with COVID-19-associated pneumonia and changes in liver enzyme activity. Material and methods: 116 patients (56 men and 60 women) were examined. All patients underwent a complex of medical rehabilitation on an outpatient basis on the 10–12th day after discharge from the hospital and in the presence of 2 negative results of PCR tests for SARS-CoV-2, which included, in addition to the recommended measures (drug therapy and exercise therapy), vacuum labile massage according to the author's methodology and a course of hepatoprotective drugs. Depending on the latter, the patients were divided into two groups: I — the main group (n=60) — received remaxol in the drug treatment regimen: 400 ml, intravenously, drip, in a course of 10 days, II – comparison (n=56) — ademetionine: 400 ml, intravenously, drip, in 0.9% saline, in a course 10 days. Before rehabilitation and at its end, the following tests were carried out: Stange and Genchi tests;quality of life was assessed using the SF-36 questionnaire. Laboratory studies included determination of the following indicators levels: ALT, AST, their ratio, alkaline phosphatase, GGT, total and direct bilirubin, LDH, albumin and total protein levels. Results. The inclusion of hepatoprotectors in the medical rehabilitation of the patients of this group contributes to a decrease in cytolytic and cholestatic syndromes, which is more pronounced in patients who received remaxol: (a decrease in AST by 1.5 times (from 35.4±1.4 to 23.5±l), and ALT — by 1.8 times (from 38.7±1.3 to 21.5±0.4 IU/l), as well as normalization of bilirubin metabolism: a decrease of total bilirubin by 2.1 times (from 32.1± 0.6 to 14.8±0.9 µmol/l) and of direct — by 2.5 times (from 7.1±0.6 to 2.8±0.1 µmol/l). A pronounced increase in resistance to hypoxia was noted during the therapy with the drug (according to Stange and Genche), which contributed to an improvement in psychophysiological indicators of patients’ quality of life (according to the SF-36 questionnaire). The obtained results, along with the safety of the drug, allow us to recommend its use in patients with this pathology.

Meglumine sodium succinate to correct covid-19-associated coagulopathy: The feasibility study

Aim of the study: to evaluate the effect of meglumine sodium succinate (MSS) on the efficacy of anticoag-ulant therapy in patients with severe COVID-19 infection complicated by bilateral community-acquired pneu-monia. Materials and methods. Overall efficacy of treatment was analyzed in 12 patients hospitalized to ICU with the diagnosis of severe confirmed COVID-19 coronavirus infection (U07.1) complicated by bilateral multiseg-mental pneumonia. All patients received prophylactic anticoagulation with unfractionated heparin. The patients were divided into two groups: 7 of them received a multi-electrolyte solution containing MSS 5 ml/kg daily for the entire ICU stay (3-10 days) as a part of therapy;5 patients received a similar volume of a conven-tional multi-electrolyte solution containing no metabolically active substrates and comprised a control group. Coagulation parameters were measured in arterial and venous blood of all patients at the following stages: 1) upon admission to the ICU;2) 2-4 hours after the first dose of heparin;3) 8-12 hours after the second dose of heparin;4) 24 hours after the beginning of intensive therapy. On the 28th day of follow-up, mortality, duration of ICU stay, and incidence of thrombotic complications in the groups were evaluated. Nonparametric methods of statistical analysis were used to assess intragroup changes and intergroup differences. Results. The group of patients administered with MSS had significantly fewer thromboembolic events during 28 days of treatment and shorter ICU stay. These patients responded faster to anticoagulant therapy, which was suggested by more distinct changes in coagulation parameters, i.e. increased APTT, persisting viable thrombocyte population, reduced D-dimer and fibrinogen levels. Conclusion. The metabolic action of succinate possibly increases endothelial resistance to damaging factors and reduces its procoagulant activity. The hypothesis requires testing in a larger clinical study with a design including laboratory evaluation of the efficacy of varying doses of the studied drug as well as aiming at eluci-dation of the mechanisms of its effect on specific pro-and anticoagulation system components.

A new look at the correction of COVID-19-mediated pulmonary gas exchange disorders

Aim. To assess the effect of meglumine sodium succinate on the effectiveness of basic therapy in correcting gas exchange abnormalities in patients with severe COVID-19 infection complicated by bilateral community-acquired pneumonia. Methods. The analysis of the effectiveness of therapy of 12 patients with a diagnosis of "New coronavirus infection COVID-19 (confirmed), severe form U07.1. Complication: Bilateral multifocal pneumonia" was carried out. The patients were divided into two groups: 7 received, as part of standard therapy, a solution of meglumine sodium succinate in a daily dose of 5 ml/kg during stay in the intensive care unit;5 patients received a similar volume of Ringer's solution and formed the control group. In the arterial and venous blood of all patients, the indicators of acid-base state and water-electrolyte balance, glycemia and lactatemia were measured at several stages: (1) at admission to the intensive care unit, (2) 2-4 hours after the start of intensive therapy, (3) after 8-12 hours, (4) after 24 hours. On the 28th day of observation, mortality, the duration of treatment in the intensive care unit and the incidence of thrombotic complications in the groups were assessed. The Friedman nonparametric hypothesis test was used to assess intragroup dynamics, and the nonparametric Mann-hitney U test for intergroup comparisons. Results. In the group of patients who received meglumine sodium succinate, there was a significant decrease in the incidence of thromboembolic events during 28 days of treatment: Myocardial ischemia event rate ratio from 0.89 [95% confidence interval (CI) 0.19-1.16] in the control group to 0.55 (95% CI 0.06-0.81) in the study group at p=0.043;pulmonary embolism event from 0.50 (95% CI 0-1.0) in the control group to 0.28 (95% CI 0-1.0) in the study group at p=0.041. There was also a decrease in the duration of intensive care unit length of stay to 6.1±1.1 days in the study group versus 8.9±1.3 days in the control group. Conclusion. Compared with standard infusion therapy, the use of meglumine sodium succinate leads to a faster normalization of ventilation-perfusion ratios in patients with severe coronavirus infection. © 2021 Eco-Vector LLC. All rights reserved.