[Treatment of toxic hepatitis in COVID-19 patients].

BACKGROUND: The article reflects the clinical significance of the early diagnosis of toxic hepatitis in patients who have undergone a new coronavirus infection with the determination of clinical and laboratory predictors of the response to therapy. A dynamic analysis of the effectiveness of toxic hepatitis therapy in patients of three experimental groups and a control group is presented. AIM: The aim of the present study is to increase the effectiveness of the treatment of toxic hepatitis in patients who have undergone COVID-19. MATERIALS AND METHODS: On the basis of the newly created infection centers of the Central Clinical Hospital "RZhD-Medicine" and Vishnevsky 3-rd Central Military Clinical Hospital 996 patients with COVID-19, who had clinical and laboratory signs of toxic liver damage (cytolytic and/or cholestatic syndromes) against the background of COVID-19 therapy. RESULTS: On the 14th day from the start of therapy in group 3, there was a significant decrease in the clinical manifestations of jaundice in 163 (72.8%) patients, on the 21st day of treatment, this symptom was stopped in all patients. In groups 1 and 2, the decrease in clinical manifestations of jaundice was significantly lower - 122 (55.2%) and 134 (58.8%); p<0.05. At the end of therapy, no manifestations of jaundice were observed in all experimental groups, while in the control group, symptom reduction was achieved only in 47 (14.5%) patients. CONCLUSION: The use of drugs with hepatoprotective effect in the form of monotherapy in groups 1 (UDCA) and 2 (ademethionine) showed a low therapeutic effect with positive dynamics of clinical and laboratory indicators of toxic hepatitis activity. The use of combined treatment in group 3 (UDCA and ademethionine) demonstrated the maximum therapeutic effect, pronounced positive dynamics in the form of normalization of clinical and laboratory indicators of toxic hepatitis activity.

[Liver disease during the pandemic of COVID-19 infection: prediction of the course and tactics of management: A review].

The hepatic consequences of SARS-CoV-2 infection are now recognized as an important component of CoronaVIrus Disease 2019 (COVID-19). This aspect is most clinically relevant in patients with pre-existing chronic liver disease (CKD), who are at extremely high risk of severe COVID-19 and death. Risk factors for severe CKD, especially in people with liver cirrhosis and non-alcoholic fatty liver disease, are the direct and indirect cytotoxic effects of coronavirus against the background of systemic inflammation, blood clotting disorders and immune dysfunction. The severe negative impact of the pandemic in the presence of CKD and the difficulties of patient relationships contribute to the progressive increase in the global burden of liver disease on the health system.

[Efficacy of Saccharomyces boulardii CNCM I-745 probiotic drug in the prevention and treatment of diarrhea in hospitalized patients with new coronavirus infection COVID-19].

AIM: To evaluate the efficacy of Saccharomyces boulardii (S. boulardii) CNCM I-745 probiotic drug in preventing and treating diarrhea in hospitalized patients with COVID-19. MATERIALS AND METHODS: A prospective comparative study was conducted in two parallel groups. The study included males and females aged 18 to 60 with the following diagnosis confirmed by polymerase chain reaction: U07.2 Coronavirus infection COVID-19, caused by SARS-CoV-2 virus (grade 1-3 pneumonia according to CT scan). All patients received antibiotic therapy. The patients were subdivided into two equal groups (n=60) depending on the administration of S. boulardii CNCM I-745 probiotic drug in addition to standard treatment. The probiotic was prescribed by the attending physician; the dose was 2 capsules per day (500 mg/day) 30 min before the meal for 10 days. All patients were monitored for main clinical, laboratory, and instrumental parameters during the study. In addition, the symptom of diarrhea (stool with a frequency of more than 3 times a day of type 6 and 7 according to the Bristol stool scale), including its frequency, duration, and the number of bowel movements of loose stool per day were precisely evaluated in both groups. RESULTS: In the overall patient pool, diarrhea was reported in 21.7% of in-patients during the observation period (95% confidence interval [CI] 14.2-29.1) with a mean duration of 4.6154 days (95% CI 3.7910-5.4398). The incidence of diarrhea in group 1 was 13.3% (95% CI 4.5-22.2), and in group 2, it was 30.0% (95% CI 18.1-41.9). Relative risk showed that the use of the S. boulardii CNCM I-745 probiotic drug leads to a significant reduction in the risk of diarrhea in hospitalized patients with COVID-19 infection receiving antibiotic therapy (odds ratio [OR] 0.3590, 95% CI 0.1421-0.9069; p=0.0303). In group 1, the duration of diarrhea was 3.1250 days (95% CI 2.5892-3.6608) versus 5.2778 days (95% CI 4.2290-6.3265) in group 2, p=0.0112. The mean daily frequency of loose stools in patients with diarrhea in group 1 was 3.2500 (95% CI 2.6588-3.8412) versus 4.3889 (95% CI 3.7252-5.0525) in group 2, p=0.0272. The secondary endpoint, duration of hospital stay, was also significantly shorter in group 1 patients - 11.6833 days (95% CI 11.2042-12.1625) versus 12.7333 days (95% CI 12.1357-13.3309) in group 2, p=0.0120. CONCLUSION: The present prospective comparative study demonstrated that adding S. boulardii CNCM I-745 probiotic drug into the standard treatment regimen of patients with new coronavirus infection COVID-19 receiving antibiotic therapy helps reduce the incidence of diarrhea and its severity during hospitalization, as well as the duration of hospital stay.

First experience of using casirivimab/imdevimab in COVID-19 in the Russian Federation.

The lack of effective etiotropic therapy is a serious challenge in the treatment of patients with COVID-19. The recent emergence of a new class of medications neutralizing monoclonal antibodies against the SARS-CoV-2 spike protein allows to partially solve this problem. This article presents a clinical case of a patient with an increased risk of COVID-19 complications (paroxysmal atrial fibrillation, atherogenic dyslipidemia, impaired carbohydrate tolerance) who was treated with 600 mg casirivimab and 600 mg imdevimab by intravenous infusion. A significant improvement in the patient's well-being was noted within the first 24 hours: normalization of body temperature, stool, reduction of weakness, disappearance of arthralgia and myalgia. After 48 hours, a negative test result for SARS-CoV-2 RNA was obtained, which altogether made it possible to state the recovery. There were no adverse events during and after therapy. The casirivimab and imdevimab monoclonal antibody combination may be considered as a promising etiotropic treatment for COVID-19. Copyright © 2022, Dynasty Publishing House.

Prospects for studying the role of some essential and toxic trace elements in the pathogenesis of COVID-19

Introduction. Factors affecting the severity of the course of a new coronavirus infection remain unexplored to the end Aim. To study the factors associated with the transition of COVID-19 from moderate to severe form of the disease in patients undergoing inpatient treatment Materials and methods. The diagnosis of COVID-19-associated pneumonia was made by a clinician on the basis of PCR test data and an up-to-date chest CT scan. A total of 195 consecutively recruited patients were examined. The average age of the surveyed was 54 (12.1) years. Results. Significantly more patients with severe coronavirus infection at the time of hospitalization were active tobacco smokers (33 (29.73%) vs 67 (79.6%);p < 0.002) and had a BMI consistent with pre-obesity/obesity (42 (37.84%) vs 44 (52.38%);p = 0.027). In patients with severe COVID-19, a significantly higher content of leukocytes was noted in the complete blood count (6.054 (2.813) vs 7.307 (4.707);p = 0.021). The groups also differed significantly in the content of micro-and macroelements. The imbalance of minerals revealed in our study is published for the first time, because. The study of the content of Al, B, Li, Co, Sr and Si in patients with COVID-19 was not carried out. Conclusion. The revealed changes in the microelement status require further study to confirm their significance in the development of a severe form of a new coronavirus infection in patients. © 2022, Remedium Group Ltd. All rights reserved.

Prospects for studying the role of some essential and toxic trace elements in the pathogenesis of COVID-19

Introduction. Factors affecting the severity of the course of a new coronavirus infection remain unexplored to the end Aim. To study the factors associated with the transition of COVID-19 from moderate to severe form of the disease in patients undergoing inpatient treatment Materials and methods. The diagnosis of COVID-19-associated pneumonia was made by a clinician on the basis of PCR test data and an up-to-date chest CT scan. A total of 195 consecutively recruited patients were examined. The average age of the surveyed was 54 (12.1) years. Results. Significantly more patients with severe coronavirus infection at the time of hospitalization were active tobacco smokers (33 (29.73%) vs 67 (79.6%);p < 0.002) and had a BMI consistent with pre-obesity/obesity (42 (37.84%) vs 44 (52.38%);p = 0.027). In patients with severe COVID-19, a significantly higher content of leukocytes was noted in the complete blood count (6.054 (2.813) vs 7.307 (4.707);p = 0.021). The groups also differed significantly in the content of micro-and macroelements. The imbalance of minerals revealed in our study is published for the first time, because. The study of the content of Al, B, Li, Co, Sr and Si in patients with COVID-19 was not carried out. Conclusion. The revealed changes in the microelement status require further study to confirm their significance in the development of a severe form of a new coronavirus infection in patients. © 2022, Remedium Group Ltd. All rights reserved.

First experience of using casirivimab/imdevimab in COVID-19 in the Russian Federation

The lack of effective etiotropic therapy is a serious challenge in the treatment of patients with COVID-19. The recent emergence of a new class of medications neutralizing monoclonal antibodies against the SARS-CoV-2 spike protein allows to partially solve this problem. This article presents a clinical case of a patient with an increased risk of COVID-19 complications (paroxysmal atrial fibrillation, atherogenic dyslipidemia, impaired carbohydrate tolerance) who was treated with 600 mg casirivimab and 600 mg imdevimab by intravenous infusion. A significant improvement in the patient's well-being was noted within the first 24 hours: normalization of body temperature, stool, reduction of weakness, disappearance of arthralgia and myalgia. After 48 hours, a negative test result for SARS-CoV-2 RNA was obtained, which altogether made it possible to state the recovery. There were no adverse events during and after therapy. The casirivimab and imdevimab monoclonal antibody combination may be considered as a promising etiotropic treatment for COVID-19. Copyright © 2022, Dynasty Publishing House.

[Composition of oropharyngeal microbiota in patients with COVID-19 of different pneumonia severity].

AIM: To identify features of the taxonomic composition of the oropharyngeal microbiota of COVID-19 patients with different disease severity. MATERIALS AND METHODS: The study group included 156 patients hospitalized with confirmed diagnosis of COVID-19 in the clinical medical center of Yevdokimov Moscow State University of Medicine and Dentistry between April and June 2021. There were 77 patients with mild pneumonia according to CT (CT1) and 79 patients with moderate to severe pneumonia (CT2 and CT3). Oropharyngeal swabs were taken when the patient was admitted to the hospital. Total DNA was isolated from the samples, then V3V4 regions of the 16s rRNA gene were amplified, followed by sequencing using Illumina HiSeq 2500 platform. DADA2 algorithm was used to obtain amplicon sequence variants (ASV). RESULTS: When comparing the microbial composition of the oropharynx of the patients with different forms of pneumonia, we have identified ASVs associated with the development of both mild and severe pneumonia outside hospital treatment. Based on the results obtained, ASVs associated with a lower degree of lung damage belong predominantly to the class of Gram-negative Firmicutes (Negativicutes), to various classes of Proteobacteria, as well as to the order Fusobacteria. In turn, ASVs associated with a greater degree of lung damage belong predominantly to Gram-positive classes of Firmicutes Bacilli and Clostridia. While being hospitalized, patients with severe pneumonia demonstrated negative disease dynamics during treatment significantly more often. CONCLUSION: We have observed differences in the taxonomic composition of the oropharyngeal microbiota in patients with different forms of pneumonia developed outside hospital treatment against COVID-19. Such differences might be due to the presumed barrier function of the oropharyngeal microbiota, which reduces the risk of virus titer increase.

Evaluation of the efficacy and safety of remdesivir in hospitalized patients with a new coronavirus infection COVID-19: data from a Russian university clinic

Introduction. The use of remdesivir in patients with the new coronavirus infection COVID-19 is known to improve the prognosis of the disease. But there is not enough data on efficacy and safety of remdesivir use in patients from Russia. Aim. To evaluate the efficacy and safety of remdesivir in patients with COVID-19. Materials and methods. A comparative prospective study was conducted in two parallel groups. The study enrolled 300 patients diagnosed with COVID-19 (grade 1–3 severe pneumonia according to CT scan), who were divided into two groups (n = 150 in each) according to the prescription of remdesivir. Treatment efficacy was assessed by recording cases of disease progression and adverse outcomes. The safety of therapy was assessed by hepatotoxicity and nephrotoxicity. Results. Patients receiving remdesivir were significantly less likely to be transferred to the intensive care unit (OR 0.3884, 95% CI: 0.1645–0.9175) and to be on artificial ventilation (OR 0.3830, 95% CI: 0.1539–0.9527). Treatment with remdesivir had no significant effect on mortality (OR 0.4932, 95% CI: 0.08897–2.7346) and complications (OR 0.4391, 95% CI: 0.1623–1.1879), including acute respiratory distress syndrome (OR 0.3919, 95% CI: 0.07483–2.0524). The duration of hospitalization was significantly short-er in group 1 patients – 12.2533 days (95% CI: 11.4101–13.0966) compared to group 2 – 14.5267 days (95% CI: 13.5125–15.5408). Hepatotoxicity with remdesivir (OR 1.5376, 95% CI: 0.8035–2.9426), nephrotoxicity (OR 1.6338, 95% CI: 0.522–5.1141) were noted, but no statistically significant difference was found (p > 0.05). Conclusions. The addition of remdesivir to the basic regimen of patients with new coronavirus infection COVID-19 improved the course of the disease, reducing the risks of patients being transferred to the intensive care unit and of receiving artificial ventilation. © 2022, Remedium Group Ltd. All rights reserved.

Features of the course of COVID-19 in patients with comorbid pathology

Comorbidity is an important problem of modern medicine, the study of which is a priority for public health. According to the literature, the prevalence of comorbidity reaches a third of the population in some countries, while there is a tendency for an increase in the number of such patients in all age groups. In the context of the COVID-19 pandemic, the presence of comorbidity in patients is a significant risk factor affecting the course and prognosis of a new coronavirus infection;at the same time, it is comorbid patients who belong to the most vulnerable group. The review presents data indicating a significant impact of comorbid pathologies on an increase in the number of complications and mortality;the most common combinations of diseases in patients with a new coronavirus infection were analyzed. There is an increase in the prevalence of comorbidity in all age groups, which dictates the need to develop an integrated interdisciplinary approach for such patients. The vast majority of clinical guidelines for the treatment of comorbidities in COVID-19 are mainly focused on individual diseases, which limits the use of these algorithms in comorbid patients. Due to the high risk of contracting a viral infection, as well as the frequent development of complications and mortality in comorbid patients, preventive measures should be focused simultaneously on two tasks: Measures aimed at preventing infection with COVID-19 and compensating for comorbid pathology. In the case of SARS-CoV-2 infection, careful monitoring of such patients, most often in a hospital setting, is necessary in order to prevent complications and adverse outcomes. © 2022, Remedium Group Ltd. All rights reserved.

The outpatient medical care in patients with chronic diseases under dispensary supervision in the conditions of the COVID19 pandemic. Temporary guidelines. Version 2

The aim of these guidelines is to provide primary care physicians with scientifically based algorithms for the implementation of dispensary monitoring in patients with chronic noncommunicable diseases in the conditions of the new coronavirus infection (COVID19) pandemic, including the use of telemedicine technologies. The organization and conduct of highquality medical followup are the most important tasks aimed at both reducing the risks of developing complications of chronic noncommunicable diseases and reducing overall mortality, especially in the current conditions of the COVID19 pandemic. The guidelines contain clinical aspects of dispensary followup, general principles of tactics for managing patients with various chronic noncommunicable diseases in COVID19 conditions, in addition, brief checklists with options for interviewing patients with various chronic noncommunicable diseases are presented, topical aspects of the interaction of drugs used in the treatment of chronic noncommunicable diseases with antiviral drugs are considered. The guidelines are intended for general practitioners, district therapists, general practitioners (family doctors), as well as doctors of other specialties providing primary health care. © 2022 Vserossiiskoe Obshchestvo Kardiologov. All rights reserved.

[Prevalence and prognostic value of gastroenterological manifestations of COVID-19: data from the Russian University Clinic].

AIM: Assessment of the prevalence and prognostic value of gastroenterological manifestations in patients with COVID-19. MATERIALS AND METHODS: A single-center retrospective cohort study was carried out. Only cases with laboratory confirmed detection of SARS-CoV-2 virus RNA using polymerase chain reaction in oro-/nasopharyngeal smear samples were subject to analysis. Patients with documented (according to anamnestic data and/or according to examination data during hospitalization) organic pathology of the gastrointestinal tract (GIT) and/or hepatobiliary system, malignant neoplasms of any localization, as well as pregnant patients were excluded from the general register of retrospective data. The final cohort was divided into two groups depending on the presence of gastrointestinal symptoms: COVID-19 with gastrointestinal symptoms (cases) and COVID-19 without gastrointestinal symptoms (control). RESULTS: The final sample consisted of 3764 patients, including 2108 (56%) women and 1656 (44%) men. The average age of the subjects included in the analysis was 58.0 years (95% confidence interval CI 48.663.0). In the study cohort, gastroenterological manifestations (alone or in combination) were recorded in 885 (23.51%) patients. Calculation of the odds ratio (OR) of unfavorable and lethal outcomes between the analyzed groups showed that the presence of gastroenterological symptoms significantly increases the chances of lethal outcome in a cohort of elderly and senile patients (OR 1.6817, 95% CI 1.03352.7364; p=0.0364), determines a higher risk of hospitalization or transfer to the intensive care unit (OR 1.2959, 95% CI 1.05471.5922; p=0.0136), development of acute respiratory distress syndrome (OR 1.5952, 95% CI 1.31641.9329; p0.0001), as well as the need for mechanical ventilation (OR 1.2849, 95% CI 1.0771.5329; p=0.0054). CONCLUSION: The present study has demonstrated that gastroenterological symptoms are detected in about one in four patients infected with the SARS-CoV-2 virus and multiply the risk of adverse and life-threatening complications of COVID-19.

[Novel coronavirus infection COVID-19: extrapulmonary manifestations].

The novel coronavirus infection COVID-19 in most cases manifests with respiratory symptoms and fever, however, some patients may have cardiovascular and gastroenterological manifestations. A feature of the clinical syndrome of COVID-19 is the development of pronounced immunopathological reactions and disorders of hemostasis, leading to the development of a wide range of cardiovascular complications. The course of COVID-19 may be complicated by the development of acute myocardial infarction, venous and arterial thrombosis and thromboembolism in various vascular pools, the development of acute myocardial damage and myocarditis. Among the gastroenterological manifestations, diarrhea, nausea or vomiting, as well as abdominal pain, are most often detected. These symptoms may precede the appearance of respiratory signs of the disease, and in some cases come to the fore in the clinical picture of the disease. In addition, in some patients there are laboratory signs of liver injury (increased serum transaminases). The exact pathogenesis of the above disorders continues to be studied.