Impact of covid-19 pandemic on gastroenterology: Chronic gastroenterological diseases, iatrogenesis and endoscopy.

The current article describes the course and treatment of chronic gastrointestinal diseases during the COVID-19 pandemic. We analyzed articles about iatrogenic harm to the gastrointestinal tract by etiological and pathogenetic therapy of the COVID-19. National and international recommendations for gastrointestinal endoscopy for infected and uninfected patients are analyzed.Copyright © A.M. SHCHIKOTA, I.V. POGONCHENKOVA, E.A. TUROVA, M.A. RASSULOVA, M.S. FILIPPOV.

Gastrointestinal tract, liver, and pancreas affected by covid-19.

We reviewed literature about the effects of novel coronavirus disease COVID-19 on the digestive system. The review ses the pathogenesis, the natural history, and the frequency of gastrointestinal and hepatobiliary complications in patientCOVID-19. We briefly overviewed therapy for intestinal, liver, and pancreatic damage by COVID-19.Copyright © 2021, Media Sphera Publishing Group. All rights reserved.

[Capacity of vibroacoustic therapy for correction of respiratory manifestations of post COVID-19 syndrome]. / Vozmozhnosti vibroakusticheskoi terapii v korrektsii respiratornykh proyavlenii postkovidnogo sindroma.

The search for therapeutic strategies for the correction of post COVID-19 syndrome is an urgent task of medicine. One of the frequent manifestations of post COVID-19 syndrome is the prolonged persistence of respiratory syndromes - dyspnea and cough. Vibroacoustic therapy is promising methods in the complex effect on broncho-pulmonary symptoms of COVID-19. OBJECTIVE: To study the effect of vibroacoustic pulmonary therapy implemented through the BARK VibroLUNG apparatus on the clinical and instrumental parameters of patients undergoing COVID-19 with residual respiratory symptoms. MATHERIAL AND METHODS: The effect of vibroacoustic therapy (5-day course of 2 sessions) on dyspnea and cough and respiratory function in 60 patients aged 18 to 75 years who underwent COVID-19 of varying severity for more than 12 weeks before the start of the study, with the presence of distant respiratory symptoms, was investigated. Patients were divided into two equal and age-matched groups - without (1st) and with (2nd) chronic bronchopulmonary pathology. RESULTS: Analysis of comorbidity of patients with respiratory phenotype of post COVID-19 syndrome showed frequent presence of concomitant cardiovascular pathology (76.7%). The predominant patient complaint was dyspnea (93.3% in both groups): 29 patients (96.7%) in the non-lung group, and 27 patients (90%) in the chronic lung group. The mean mMRC dyspnea score for all patients was 1.1±0.49 points (1.2±0.5 points in the first group and 1.0±0.45 points in the second group). Cough was observed less often - in 18 patients of both groups (30%), mainly in the second group. During the course of vibroacoustic therapy in the 1st group, the number of patients with dyspnea decreased from 96.7 to 30%, in the 2nd group - from 90 to 10%, the total mean mMRC dyspnea score decreased to 0.2±0.4 (Δ 82%), and a complete regression of cough syndrome was achieved in both groups. Also, an increase in forced expiratory volume in 1st second and peak expiratory flow indicators was revealed both in the general group of patients and in the group of patients without chronic lung pathology. CONCLUSION: The results obtained during the study of the use of vibroacoustic therapy in patients with respiratory manifestations of post-COVID syndrome, including the presence of chronic bronchopulmonary pathology, allow us to conclude on the effective correction of dyspnea and cough during treatment. Vibroacoustic therapy is a promising non-drug method of exposure to bronchopulmonary manifestations of post-COVID syndrome in patients during rehabilitation.

Сlinical Efficacy of Individually Dosed Intermittent Hypoxia-Hyperoxic Therapy in Osteoarthritis Patients with Post-Covid Syndrome

Aim. To evaluate the clinical efficiency of the individually dosed interval hypoxia-hyperoxic therapy in the medical rehabilitation of patients with osteoarthritis (OA), having post-COVID syndrome. Material and methods. 50 patients with OA (84% females, age of 43 to 68 years) where included in the randomized placebo-controlled study. Coronavirus infection COVID-19 were diagnosed from 12 to 26 weeks before the study. Patients had at least 6 symptoms of post-COVID syndrome. All patients were randomized into 3 groups. 18 patients of the study group received 10 hypoxia-hyperoxic therapy procedures, 15 comparison group patients – 10 placebo procedures, 14 control group patients – only standard rehabilitation. The study group patients were breathing hypoxic (FiO2 13–15%) and hyperoxic (FiO2 up to 40%) gas mixture through the mask in the interval mode using device ReOxy. The duration of 1–4 procedures was 30 min, 5–10 procedures – 40 min. The placebo procedures were performed using the mask with the atmospheric air hole. The standard rehabilitation program in all groups for 2 weeks included: 10 group sessions of physical exercises with elements of breathing exercises, 10 procedures of magnetic therapy for joints, 10 sodium chloride baths. Joint pain and general health on 100-mm visual analog scale, Lequesne and WOMAC indexes, Spielberger-Khanin reactive anxiety test, Beck depression inventory and breathlessness on Modified Borg scale were evaluated at baseline (control point T0) and at 2 weeks (control point T1). Results and discussion. After 2 weeks (T1) in the study group, pain decreased by 51.4% (p < 0.01), Lequesne index – by 34.8% (p < 0.05), WOMAC – by 44.7% (p < 0.05), reactive anxiety level – by 23.7% (p < 0.05), depression symptoms – by 52.9% (p < 0.01), breathlessness – by 71.2% (p < 0.01), general health improved by 52.1% (р < 0.01). In the study group, there were statistically significant differences from the control group in all parameters (р < 0.05) and from the comparison group in most indicators (р < 0.05), excluding the Lequesne index. These results are consistent with the data of modern studies of efficiency of hypoxic conditioning. Conclusion. 2-week rehabilitation program, including interval hypoxia-hyperoxic therapy, reduces pain, breathlessness, depression and reactive anxiety symptoms, improves general health and functional status in patients with OA, having post-COVID syndrome. © 2022 Vestnik Vosstanovitel'noj Mediciny. All rights reserved.

[COVID-19-associated diarrhea].

In addition to the typical clinical picture of respiratory symptoms and intoxication, the SARS-CoV-2 virus is also characterized by a gastroenterotropic effect. Diarrhea is one of the most common gastroenterological symptoms of COVID-19 and is detected, according to the various authors, in 2-49.5% of cases, including children. The presence of diarrhea aggravates the patient's clinical condition, limits the possibility of carrying out the necessary diagnostic manipulations, and complicates the selection of therapy. The article provides an overview of the scientific literature on the formation of diarrheal syndrome in patients with COVID-19. Objective. Analysis of scientific publications studying the pathogenesis, incidence, clinical features, aspects of diagnosis and therapy of diarrhea in patients with COVID-19. Material and methods. A search was made for scientific publications on the electronic resources PubMed, Google Scholar and eLIBRARY.ru. Results. The pathogenesis of diarrhea in a new coronavirus infection is complex and includes, among other things, the effect of the virus on the angiotensin-converting enzyme 2 receptors, inducing an inflammatory process in the gastrointestinal tract mucosa, neurotropic effect on the autonomic regulation of intestinal motor activity, disturbance of the colon microbiota, liver and pancreas damage. Another important pathogenetic aspect of diarrhea in COVID-19 is iatrogenic one, i.e. a side effect of drugs used in the treatment of a new coronavirus infection and its complications, and the activation of opportunistic clostridial intestinal flora against the background of antibiotic therapy. The variety of pathogenetic mechanisms of diarrheal syndrome formation allows us to speak of "COVID-associated diarrhea" as an independent clinical phenomenon characteristic for the new coronavirus infection. Mandatory diagnostic algorithm of a patient with COVID-19 and diarrhea is the fecal analysis test for toxins Cl. difficile, while the possibility of endoscopic examinations during the pandemic is limited. Compliance with the hygiene measures, diet correction and nutritional support, rational antibiotic therapy of COVID-19 complications, careful use of antiperistaltic antidiarrheal drugs, nonspecific therapy (antiviral, rehydration, adsorbents) are considered as the main therapeutic approaches for diarrheal syndrome against the background of COVID-19. The administration of probiotics and antibacterials should be considered in case of confirmed clostridial co-infection. Conclusion. Diarrhea is a frequent clinical manifestation of COVID-19 and can affect the course of the disease. The complex genesis of diarrheal syndrome requires further study of therapeutic strategies and nutritional support for patients after COVID-19.

[Hyperbaric oxygenation in outpatient rehabilitation of COVID-19 convalescents]. / Primenenie giperbaricheskoi oksigenatsii v ambulatornoi reabilitatsii patsientov, perenesshikh COVID-19.

Searching for drug and non-drug modalities for the rehabilitation of patients with the post-COVID syndrome is an urgent public health challenge during the COVID-19 pandemic. Hyperbaric oxygenation is a promising method as a part of complex rehabilitation after COVID-19 due to its antihypoxic, anti-inflammatory, antioxidant and anticoagulant effects. OBJECTIVE: To study the effect of hyperbaric oxygenation as a part of comprehensive outpatient rehabilitation on clinical and functional parameters in COVID-19 convalescents. MATERIAL AND METHODS: The effect of hyperbaric oxygenation on clinical and functional parameters of 45 COVID-19 convalescents was studied: 22 males and 23 females aged 40-60 years. Patients were divided into three groups of 15 subjects each, depending on the CT stage of COVID-associated pneumonia (CT-0, CT-1, and CT-2-3). RESULTS: Patients in group 3 (CT-2-3) were on average in the older age group, had a higher body weight and a higher percentage of fat mass according to bioimpedance measurements, compared to the other groups. Most clinical-functional and laboratory parameters in this group were within normal or subnormal ranges. In addition, high cholesterol levels (total cholesterol 6.5±1.2 mmol/L) and subnormal levels of C-reactive protein (9.3 mg/L) were noted in group 3 patients. After comprehensive rehabilitation, an increase in the distance walked in the 6-minute walking test with a significant trend in the CT-0 (467.9±37.7→531.5±44.3 m; p<0.01) and CT-1 (533.9±74.3→570.1±57.8 m; p<0.05) groups was observed. A significant decrease in norepinephrine level in the group of COVID-19 convalescents with CT-2-3 (Δ 13%), and a decrease in glutathione peroxidase in all three groups (6465.0±1637.3→5101.0±1353.3, 6587.8±1919.3→5418.1±1289.7, 7699.5±1747.9→6620.1±1702.1 units/L in groups 1, 2 and 3, respectively; p<0.05) were recorded. CONCLUSION: The use of hyperbaric oxygenation in comprehensive outpatient rehabilitation of COVID-19 convalescents was associated with benefits, given the improvement of functional parameters, laboratory signs of limiting low-grade inflammation, sympathoadrenal activity, and oxidative stress.

Coronavirus disease 2019: Features of comprehensive cardiac and pulmonary rehabilitation

The expert consensus of the Russian communities discusses the issues of comprehensive medical rehabilitation of patients with coronavirus disease 2019 (COVID-19). COVID-19 is a contagious infectious disease that can cause pulmonary, cardiac, motor, metabolic, neurocognitive and mental disorders, that is, multiple organ dysfunction. COVID-19 survivors, especially after a severe clinical course, face serious psychological and physical problems, posttraumatic stress, cognitive dysfunction, nutritional deficiencies and exacerbation of concomitant chronic diseases. Some patients, regardless of the COVID-19 severity, have a long clinical course of the disease (“chronic-COVID”, “long COVID”). There is evidence of post-acute COVID-19 syndrome. In this regard, patients after COVID-19 will need rehabilitation measures. The expert consensus of the Russian communities presents general principles, stages and aspects of medical rehabilitation after COVID-19, indications and contraindications for rehabilitation interventions. The paper includes recommendations on comprehensive cardiac and pulmonary rehabilitation, as well as specifics of rehabilitation care for different COVID-19 courses within the national three-stage rehabilitation system.

Impact of covid-19 pandemic on gastroenterology: Chronic gastroenterological diseases, iatrogenesis and endoscopy

The current article describes the course and treatment of chronic gastrointestinal diseases during the COVID-19 pandemic. We analyzed articles about iatrogenic harm to the gastrointestinal tract by etiological and pathogenetic therapy of the COVID-19. National and international recommendations for gastrointestinal endoscopy for infected and uninfected patients are analyzed. © A.M. SHCHIKOTA, I.V. POGONCHENKOVA, E.A. TUROVA, M.A. RASSULOVA, M.S. FILIPPOV.

Gastrointestinal tract, liver, and pancreas affected by covid-19

We reviewed literature about the effects of novel coronavirus disease COVID-19 on the digestive system. The review ses the pathogenesis, the natural history, and the frequency of gastrointestinal and hepatobiliary complications in patientCOVID-19. We briefly overviewed therapy for intestinal, liver, and pancreatic damage by COVID-19. © 2021, Media Sphera Publishing Group. All rights reserved.

Cardiological Rehabilitation and COVID-19 Pandemic: Literature Review

Objective of the Review: To review literature data on the need for cardiological rehabilitation of COVID-19 survivors and the features of rehabilitation of patients with cardiovascular pathologies during pandemic. Key Points. SARS-CoV-2 virus uses several cardiotropic mechanisms and can damage the myocardium. The COVID-19 pandemic can result in an increase in the number of patients with acute and chronic cardiological pathologies who require rehabilitation. Traditional cardiological rehabilitation has a limited range of measures during a pandemic;the majority of experts recommend rehabilitation at home and using telemedicine. Conclusion. COVID-19 survivors can need cardiological rehabilitation. Remote management is a key trend in cardiological rehabilitation during a pandemic. Цель обзора: анализ литературных данных о потребности в кардиореабилитации у больных, перенесших COVID-19, и особенностях реабилитации пациентов с сердечно-сосудистой патологией в период пандемии. Основные положения. Вирус SARS-CoV-2 имеет несколько механизмов кардиотропного действия и может вызывать повреждение миокарда. В результате пандемии COVID-19 возможно увеличение числа пациентов с острой и хронической кардиологической патологией, нуждающихся в реабилитации. Возможности традиционной кардиологической реабилитации в условиях пандемии ограничены;большинство экспертов рекомендуют реабилитацию в домашних условиях и использование телемедицинских технологий. Заключение. Пациенты, перенесшие COVID-19, потенциально нуждаются в проведении кардиореабилитации. Применение дистанционных методов является основным вектором развития кардиологической реабилитации в период пандемии.

Chronic obstructive lung disease and COVID-19: Topical issues

The problem of comorbidity of new coronaviral infection (COVID-19) and chronic obstructive pulmonary disease (COPD) is acute, considering similarity of clinical manifestations, diagnostic difficulties, the potential severe disease course. Patients with COPD represent a vulnerable group of infected SARS-CoV-2, with a complicated disease course and frequent adverse outcome. Features of the spread of the virus limit treatment and diagnosis for patients with COPD, making it difficult to provide medical care during the pandemic. The negative results of some clinical studies of antiviral drugs for patients with COVID-19 indicate the need for a search for new drugs;for this reason, analysis of the anti-inflammatory effect on the lungs in infection COVID-19 of drugs of basic COPD therapy is promising. © 2020 Medical Education. All rights reserved.