ABSTRACT
Objective. To study the peculiarities of diagnostics and treatment of urolithiasis complications among patients with new coronavirus infection COVID-19. Methods. The prospective cohort study evaluated the treatment outcomes of patients (n=146). The first group (n=30) included patients treated in infectious diseases hospital with a complicated urinary calculi disease and a new coronavirus infection COVID-19, the second group (n=116) included patients treated in the urological department of multidisciplinary non-infectious hospital due to complicated urinary tract stone disease who were not infected by new coronavirus infection COVID-19. As for COVID 19 diagnostics, patients of the first group were done PCR tests that were positive in 19 (63,3%) cases, and thoracic cavity computer tomography scanning (upon admission the percentage of pulmonary tissue involvement varied since 5% up to 90%). Results. Among the patients of the first group, elderly people prevailed (61+15 years) and there were more women among them (66%). The characteristic features of complicated urinary calculi disease in patients with COVID-19 are the prevalence of infectious and inflammatory complications (50%) and a combination of several complications of urolithiasis (40%). Among peculiarities of treatment, patients of the first group in 6.6% of cases underwent the lumbotomy with open nephrostomy, due to the spread of secondary suppurative process over the retroperitoneal space. According to the Clavien-Dindo scale, in the first group of patients the incidence of complications after surgery was 40%, in the second - 13.8%. Mortality rate in the first group reached 30%, in the second – 0.9%. The duration of hospital treatment among patients of the first group reached 21 (5-39) days, among patients of the second group – 8 (1-56) days. Conclusion. The specificity of the course associated with significant morbidity and mortality require further optimization therapeutic approaches to achieve success in patients with complications of urolithiasis during COVID-19 outbreak. © 2021 Vitebsk State Medical University. All rights reserved.
ABSTRACT
OBJECTIVE: To determine the optimal management of pneumomediastinum in patients with a novel coronavirus infection (COVID-19). MATERIAL AND METHODS: There were 14 patients with pneumomediastinum and COVID-19 infection without mechanical ventilation. We discussed the world data on pneumomediastinum in patients with coronavirus infection. RESULTS: Before the COVID-19 pandemic, the annual number of own observations of spontaneous pneumomediastinum did not exceed 1-2 patients. The mechanism of pneumomediastinum is explained by the Macklin effect. COVID-19 pandemic in the Russian Federation was followed by increase of the number of patients with pneumomediastinum up to 2.4% of the total number of patients in the thoracic department. In this sample, pneumomediastinum occurred at all variants of the course of coronavirus infection. The timing of pneumomediastinum ranged from 2 to 18 (median 14) days after clinical manifestation of COVID-19. In 2 out of 14 cases, pneumomediastinum was the main symptom of coronavirus infection at admission. One patient had a combination of pneumomediastinum and pneumothorax. In 6 cases, pneumomediastinum was stable and regressed under conservative therapy. Eight patients underwent Razumovsky suprajugular mediastinotomy. There were no postoperative deaths. Recurrent pneumomediastinum was noted in one patient. CONCLUSION: The causes of pneumomediastinum in some patients with coronavirus infection, peculiarities of diagnosis and treatment and clarification of indications for invasive interventions require further study.