ABSTRACT
Strains of microorganisms characterized by resistance to antimicrobial drugs used in medical organizations continue to spread In most regions of the world including Russia. It is clear that it affects both the effectiveness of antimicrobial therapy and tactics and strategy of its use not only in adults patients but also in children. The pandemic of coronavirus infection, in addition, highlighted the growing problems in treatment of invasive mycoses, the dose adjustment of antibiotics during sorption and dialysis therapy methods. These circumstances made it necessary to make adjustments to Guidelines on Diagnostics and Antimicrobial Therapy of Infections Caused by Multiresistant Strains of Microorganisms, which were prepared by a group of leading Russian experts in 2020 [1]. The submitted version of the recommendations was approved on 25.03.2022 at a joint meeting of the working group with representatives of public organizations: Association of Anesthesiologists-Intensivists, the Interregional Non-Governmental Organization Alliance of Clinical Chemotherapists and Microbiologists, the Interregional Association for Clinical Microbiology and Antimicrobial Chemotherapy (IACMAC), and NGO Russian Sepsis Forum. These recommendations reflect an interdisciplinary consensus opinion on approaches to the diagnosis and antimicrobial therapy of infections caused by multiresistant microorganisms. They are based on data from publications obtained from randomized trials as well as based on international clinical guidelines with a high degree of evidence. It is rational to use the Guidelines for determining the tactics of empirical and etiotropic therapy of the most severe infections. © 2022 by the authors.
ABSTRACT
The aim of this research work was to study the ability of SARS-CoV-2 to persist in multiple organs of people who have recovered from COVID-19. For this purpose, autopsy material was used from patients with a history of COVID-19 who died from causes unrelated to a new coronavirus infection. Autopsy material collected from 11 different organs was analyzed for the presence of SARS-CoV-2 RNA using real-time polymerase chain reaction (RT-PCR). Among the organs tested, SARS-CoV-2 RNA persisted longest in the bronchi and lungs. Thus, in both patients tested positive more than 100 days after recovery, SARS-CoV-2 RNA was detected only in the bronchi and lungs. On the contrary, the shorter the recovery time was, the more organs were found to have SARS-Cov-2 RNA. SARS-CoV-2 RNA was most frequently detected in biomaterials of deceased people over 80 years of age, which may indicate a longer period of virus elimination in the elderly. No correlation between the distribution of SARS-CoV-2 across organs and the age of patients could be detected, but it was shown that SARS-CoV-2 persisted in more organs in males after recovery. In females, SARS-CoV-2 RNA was found predominantly in the bronchi and lungs.
ABSTRACT
The aim of the study is to evaluate the efficacy of hyperbaric oxygen therapy and its effect on oxidative stress and apoptosis in patients with new coronavirus infection COVID-19. Materials and methods. 90 patients diagnosed with new coronavirus infection caused by SARS-CoV-2 virus were examined. Hyperbaric oxygen therapy sessions were conducted in 57 patients (38 in severe condition (CT 3–4), 19 in moderate condition (CT 1–2)). The procedures were performed in 1.4–1.6 ATA mode for 40 min-utes, 247 sessions in total were performed. The effect of hyperbaric oxygenation was assessed by measuring the level of oxygen saturation, the severity of oxidative stress and apoptosis of blood lymphocytes. Results. In all examined patients with new coronavirus infection caused by SARS-CoV-2, positive changes such as dyspnea reduction and improvement of general well-being were registered after hyperbaric oxygen therapy sessions. The level of oxygen saturation after the end of the hyperbaric oxygen therapy course was 95.0±1.6% (before the course — 91.3±5.9%), which allowed to return almost all patients to spontaneous res-piration without the need for further oxygenation therapy. Hyperbaric oxygen therapy did not reduce the total antioxidant activity, however, it was associated with a decrease in the blood malone dialdehyde from 4.34±0.52 µmol/l to 3.98±0.48 µmol/l and a decrease in open circuit potential of platinum electrode from-22.78±24.58 mV to-37.69±17.4 mV. Besides, the positive effect of hyperbaric oxygen therapy was manifested in normalization of blood cell apoptosis. Conclusion. Hyperbaric oxygen therapy in patients with new coronavirus infection caused by the SARS-CoV-2 virus is an effective treatment method with multiple effects resulting in improvement of subjective indicators of the patients' condition, increase of hemoglobin oxygen saturation, decrease of lipid peroxidation intensity, activation of antioxidant system, restoration of pro-and antioxidant balance and apoptosis normalization. © 2020, V.A. Negovsky Research Institute of General Reanimatology. All rights reserved.
ABSTRACT
Relevance Acute respiratory infection COVID-19 caused by the SARS-CoV-2 (2019-nCov) coronavirus is severe and extremely severe in 15-20% of cases, which is accompanied by the need for respiratory support. Hyperbaric oxygenation is recognized as an effective therapy for replenishing any form of oxygen debt. Aim of study To study the safety of HBO use in patients with COVID-19. Materia l and me thods We examined 32 patients with the diagnosis "Coronavirus infection caused by the virus SARS-CoV-2" (10 - moderately severe patients (CT 1-2), 22 - patients in serious condition (CT 3-4), who received course of hyperbaric oxygenation (HBO). The procedures were carried out in a Sechrist 2800 chamber (USA) at a mode of 1.4-1.6 AT for no more than 60 minutes. In total, the patients received 141 HBO sessions. Before and after each HBO session, the subjective indicators of the patient's condition were assessed and the blood oxygen saturation was measured. Res ults An algorithm for HBO course management was developed, which consists in using "soft" modes (up to 1.4 AT) during the first session, followed by pressure adjustment (not higher than 1.6 AT) during the course to achieve maximum therapeutic effect and comfort for the patient. Against the background of the HBO course, the patients showed an increase in blood oxygen saturation in patients in both surveyed groups, as well as positive dynamics in the form of a decrease in shortness of breath, an improvement in general well-being. Conc lusi on The inclusion of daily sessions (at least 4) of hyperbaric oxygenation in "soft" modes (1.4-1.6 ATA) in the complex therapy for COVID-19 has shown its safety and preliminary positive effect on the subjective state of the examined patients and the dynamics of blood oxygen saturation. © 2020 Sklifosovsky Research Institute for Emergency Medicine. All rights reserved.