ABSTRACT
Introduction. The COVID-19 pandemic affected not only the organization of the entire healthcare system, but also made adjustments to the diagnosis and treatment of a wide range of diseases, including diverticular disease. Aim. Analysis of the results of inpatient care for patients with acute diverticulitis during the COVID-2019 pandemic. Material and methods: From 2017 to January 2022, 244 patients with diverticular disease were treated in coloproctology clinic. During the pandemic period (March 2020 – December 2021) there were 15 patients with COVID-2019 associated pneumonia who developed complications of diverticular disease. Results and discussion. An increase of hospitalizations of patients with complicated forms of the disease was established, while patients with uncomplicated diverticular disease were hospitalized less frequently. There was also a decrease in the number of reconstructive surgeries in 2020. The most informative diagnostic tool that allows to verify complicated forms of diverticular disease and determines further treatment tactics, especially in the COVID-19 pandemic, is X-ray computed tomography with intravenous contrast, which was performed in 53.3% of patients. The number of urgent surgical interventions increased, including in patients with COVID-2019. During the pandemic, minimally invasive interventions began to be performed more often, allowing the patient to be treated as gently as possible. Moreover, drainage of abscess under ultrasound guidance is currently becoming a popular procedure even with large abscesses (>3 cm). This technology should be considered as bridge operation before a radical intervention, which implementation should be carried out after the stabilization of the general condition of the patient. Diffuse peritonitis in COVID-positive patients continues to be considered as an indication for emergency laparotomy. At the same time, Hartmann-type operations should be performed, refusing the extended intestinal resection and primary anastomosis. Conclusion. The COVID-19 pandemic has made adjustments to the organization of medical care for patients with diverticular disease. In this regard, it is advisable to conduct interdisciplinary multicenter research in order to study the influence of the pandemic on the course of the disease and take early measures to minimize the negative consequences of the pandemic. © 2022, LLC "IMC" Modern Clinical Medicine. All rights reserved.
ABSTRACT
Background: COVID-19 is a disease caused by the SARS-CoV-2 virus that is often associated with pneumonia and acute respiratory distress syndrome (ARDS). Pathogenesis of COVID-19 is closely related to the host ' s response to the virus. Impaired regulation of immunity has been observed in patients with severe COVID-19 pneumonia. Mesenchymal stem cells (MSCs), having multipotency, ability to selfrenew, and ability to evade immune response may be useful in in the treatment of COVID-19 pneumonia. MSCs have an immunomodulatory effect on almost all types of immunocompetent cells: T-and B-lymphocytes, natural killer cells, monocytes and macrophages, dendritic cells, neutrophils. This study assesses the safety and tolerability of pooled allogeneic mesenchymal stem cells (poolMSC) in COVID 19 pneumonia. Method: The study included 5 patients with PCR confirmed COVID-19 pneumonia-4 men and 1 woman, average age 62.4 years. Pooled MSC (pMSC) was a mixture of 3 cultures of olfactory mucosa-derived MSCs (OM-MSCs) obtained from the mucous membrane of the middle nasal passage of healthy volunteers. MSCs were tested for viability (>95%), immunophenotype CD90 + CD105 + CD73 + CD31-CD45-HLA-DR-, and sterility. pMSC at a dosage of 1×10 6 cells per kg of body weight were suspended in 100 ml of saline and injected intravenously over 60 minutes. Results: All patients were carefully examined at baseline before pMSC infusion. Clinical examination was done on the day of infusion of pMSC with a skin test to pMSC was performed. In the absence of systemic and local allergic reactions pMSC were injected. Three patients received one pMSC infusion, and two patients received two pMSC infusions at an interval of 4 days. None of the patients had any adverse reactions to the pMSC skin test or infusion. Conclusion: Assessment of pMSC infusion demonstrated good tolerance and safety of intravenous use in patients with severe pneumonia caused by the SARS-CoV-2 and complicated by ARDS.