Place and role of glucocorticoids in the treatment of COVID-19: from theory to practice

This article presents a pathogenetic rationale for using glucocorticoid hormones in the treatment of patients with COVID-19 based on a review of the literature. Their effect on the hypophyseal portal, immune, cardiovascular, respiratory, and nervous systems is thoroughly considered. In some cases, the use of glucocorticoids is reasonable and necessary. Drugs of this group are successfully used as a basis for the treatment of shock of different etiology, toxic and allergic reactions, bronchial obstructive syndrome, and autoimmune connective tissue disorders. The use of glucocorticoids in many diseases is justified and improves health condition. In severe infectious diseases, including COVID-19, if indicated, short courses of glucocorticoids should be used due to the high risk of adverse events. Glucocorticoid therapy for COVID-19 is necessary in case of the development of laboratory-confirmed systemic inflammatory response syndrome, the threat of cytokine storm under control of proinflammatory markers in dynamics, in combination with effective antiviral and antibacterial therapy. If a patient has a history of chronic pathology with bronchial obstructive syndrome, early prescription of glucocorticoids for the treatment of COVID-19 combined with antibacterial and antiviral therapy from the first days of the disease is justified. Copyright © 2022, Dynasty Publishing House. All rights reserved.

Optimal topical drug for COVID-19 therapy in children

Objective. To evaluate the efficacy of a benzydamine-containing drug in children with COVID-19. Patients and methods. This observational randomized study included 88 children with confirmed mild or moderate COVID-19. The experimental group comprised 44 children who received drugs containing benzydamine, whereas the control group comprised 44 children who received other local treatments. The groups were matched for age, sex, disease severity, main manifestations, and systemic therapy received. Results. Children in the experimental group demonstrated faster recovery than those from the control group (after 6.20 ± 2.93 days vs 7.36 ± 3.17 days, respectively;р < 0.05). Virus elimination occurred earlier in children receiving benzydamine than in controls (3.93 ± 2.48 days vs 5.27 ± 3.64 days, respectively;р < 0.05. Benzydamine significantly reduced the duration of pharyngeal hyperemia (by 2.29%), sore throat (by 1.77 days;р < 0.05), and fever (by 0.93 days;р < 0.05) compared to other local treatments. Conclusion. Benzydamine significantly increases the efficacy of COVID-19 treatment.

Experience in International Cooperation on Organization of Anti-Epidemic Measures by Health Care Institutions under COVID-19 Pandemic in the Republic of Uzbekistan

The results of the joint work of a panel of experts from Rospotrebnadzor and healthcare professionals of the Republic of Uzbekistan on organizing activities to counter the spread of the SARS-CoV-2 virus are described in the paper. The goal of the study was to determine the main driving forces of COVID-19 spread in the Republic of Uzbekistan and develop an action plan to reduce the incidence of coronavirus infection caused by the SARS-CoV-2 virus. Materials and methods. The organization of work in 14 health care institutions in Tashkent and Samarkand, as well as in Tashkent and Samarkand Regions, was analyzed: in 7 laboratories, 6 hospitals and 1 polyclinic. The routes for the movement of personnel, the demarcation of green and red zones, the features of disinfection and the use of personal protective equipment were studied. Attention is drawn to the diagnosis of COVID-19, the use of therapy aimed at reducing the period of virus shedding, the criteria for lifting quarantine restrictions for patients. Results and discussion. The main factors in the organization of work of institutions that contribute to the spread of COVID-19 among medical personnel and the population have been identified: the lack of equipped gateways between the red and green zones with the accessibility of adequate disinfection, the wrong choice of personal protective equipment, monitoring of contact persons for 10 days, discharge from hospitals based on clinical improvement. The incorrect use of antiviral therapy, the lack of differentiated approaches to the selection of optimal regimens have been noted. Proposals are formulated for organizing the work of healthcare institutions, taking into account the requirements of biological safety. The introduction of targeted measures in addition to those previously adopted has led to a significant improvement in the epidemic situation: the total number of active cases in the Republic of Uzbekistan, despite the increase in testing volumes, decreased from 3,686 people on August 23 to 2335 on October 27. Towards December 20, 2020, 97 % of patients recovered completely. All diagnostic triage centers in the Republic of Uzbekistan are closed due to the absence of patients with COVID-19, most of the country's medical institutions previously re-profiled for patients with coronavirus infection have returned to the routine operations. © 2021 Russian Research Anti-Plague Institute. All rights reserved.

Phase 3 trial of coronavir (favipiravir) in patients with mild to moderate COVID-19

Favipiravir has demonstrated efficacy against the SARS-CoV-2 virus in several preliminary studies. This study aimed to evaluate the efficacy and safety of favipiravir for treatment of mild to moderate COVID-19 in outpatients and hospitalized patients. We conducted an open-label, randomized, active-controlled trial of a generic form of favipiravir in patients with COVID-19 confirmed by PCR-test. Eligible patients (18-60 years) after stratification were randomly assigned (in a 2:1 ratio) to receive either favipiravir (1800 mg BID on day 1, followed by 800 mg BID for up to 9 days), or standard of care (SOC) treatment (umifenovir + intranasal interferon alpha-2b, or hydroxychloroquine) for up to 10 days. The co-primary outcomes were the time to clinical improvement and the time to viral clearance. Among 190 patients assessed for eligibility 168 were randomized to favipiravir (n=112) or to SOC (n=56) group. The median time to clinical improvement was 6.0 days (IQR 4.0;9.3) in the favipiravir group and 10.0 (IQR 5.0;21.0) days in the SOC group;the median difference was 4 days (HR 1.63;95% CI 1.14-2.34;P=0.007). The statistically significant difference in the median time to viral clearance was observed only for hospitalized patients: 3.0 (IQR 3.0;3.0) days in the favipiravir group vs. 5.0 (IQR 4.5;5.5) days in the SOC group (HR 2.11;95% CI 1.04-4.31;P=0.038). The rate of viral elimination on Day 5 in the favipiravir group was significantly higher than in SOC group: 81.2% vs. 67.9% (RR 1.22;05% CI 1.00-1.48;P=0.022). The rate of clinical improvement on Day 7 in the favipiravir group was 1.5-fold higher than in SOC group: 52.7% vs. 35.8% (RR 1.50;95% CI 1.02-2.22;P=0.020). Favipiravir was well-tolerated and the most common adverse reactions were asymptomatic hyperuricemia, transient elevation of ALT & AST, and mild gastrointestinal disorders. Favipiravir was superior to the SOC in shortening the time to clinical improvement in patients with mild to moderate COVID-19.

Experience of international cooperation in developing epidemic control measures during COVID-19 spread in the Republic of Moldova

The purpose of the study - to identify the factors contributing to the spread of the novel coronavirus infection within the territory of the Republic of Moldova and to develop measures aimed at their elimination. Materials and methods. In May 2020, experts of Rospotrebnadzor (the Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing), together with leading employees of institutions participating in planning and implementing measures aimed at prevention of COVID-19 spread, conducted a detailed analysis of epidemic control and curative measures in 10 healthcare organizations in the Republic of Moldova. They assessed the effectiveness of the undertaken actions in in-patient facilities, in laboratories, and in the country in general. Results. The existing approaches to treatment of patients with COVID-19 and to laboratory diagnostics were in line with the common practices;the adequacy of measures was evidenced by the hospital bed capacity and the stock of artificial lung ventilation machines. In the meantime, the experts came across the factors that obviously contributed to the infection spread. Their elimination could intercept some paths of infection and improve the situation. Conclusion. The analysis of the current measures and their results is important for planning and implementing actions aimed at improvement of the epidemic situation in different regions. The collaborative efforts helped slow down the outbreak in the Bender psychoneurological residential facility;outbreaks were prevented in other limited-access institutions;the incidence among healthcare workers decreased;the daily number of new COVID-19 cases decreased to 0-5 during the summer months in the Dniestrian Moldovan Republic. Presently, there is a clear picture of approaches that should be taken to decrease the incidence. Most likely, the experience obtained in the fight against the novel coronavirus infection will be of great use in future if any new variants of viruses emerge. © 2021, Central Research Institute for Epidemiology. All rights reserved.

[Effect of anticoagulant therapy on the course of COVID-19 in comorbid patients].

INTRODUCTION: Analysis of the pathogenesis of coronavirus infection caused SARS-CoV-2 indicates a significant impact of hemorheological disorders on its course and outcomes. It is known that chronic cardiovascular diseases are associated with the risk of severe course and lethal outcomes both in COVID-19 and other infectious diseases. Therefore, in each case it is necessary to study the interaction and mutual influence of different components of the treatment program prescribed to such patients.The purpose of this work was to evaluate the effect of coagulation activity on the course of a novel coronavirus infection (COVID-19) and to justify the management of comorbid patients having been received novel oral anticoagulants (NOACs) in previously selected doses according to indications in concomitant somatic diseases. MATERIAL AND METHODS: Total 76 cases of confirmed coronavirus infection in patients who had been received initial therapy on an outpatient basis were analyzed. 26 patients who received NOACs (rivaroxaban, apixaban, dabigatran) made up the main group and 50 - the comparison (control) group in which patients had not been administered any drugs that affect blood clotting until the episode of COVID-19. All patients have been prescribed therapy following the Provisional guidelines «Prevention, diagnosis and treatment of coronavirus infection (COVID-19)¼ (https://static-0.minzdrav.gov.ru/system/attachments/attaches/). RESULTS AND DISCUSSION: The number of hospitalizations was significantly fewer in the group of patients who had been received NOACs (19 vs. 66% in the control group). No deaths or cases of severe respiratory and/or renal failure were observed in the main group, while adverse outcomes were noted in 14% of patients who had not been administered these drugs. CONCLUSION: Taking NOACs reduces the probability of severe course and adverse outcomes in the development of coronavirus infection caused by SARS-CoV-2, which indicates a significant contribution of coagulation mechanisms to the pathogenesis in COVID-19. There were no indications for drug replacement and correction of anticoagulant therapy regimens in patients who received adequate therapy with oral anticoagulants for treating a non-severe form of coronavirus infection in ambulatory patient settings.

Effectiveness of pathogenetic therapy for infectious diarrhea in children with covid-19

Introduction. The article presents basic information on approaches to pathogenetic therapy of acute intestinal infections. Data from our own research on the diagnosis and treatment of gastrointestinal manifestations of COVID-19 in children aged 3 months to 18 years are presented. The aim of the study was to evaluate the effectiveness of complex rehydration, cytomucoprotective and probiotic therapy for infectious diarrhea of various etiologies, including those developing with a new coronavirus infection. Materials and methods. We analyzed data from our own observations of patients aged 3 months to 18 years with diarrhea against the background of acute intestinal infections of various etiologies (120 children), as well as with a new coronavirus infection caused by the SARS-CoV-2 virus (32 children). The children were treated in accordance with current standards and treatment recommendations. Clinical examples are presented. Results and discussion. Diarrhea was observed in 64% of patients with a new coronavirus infection. Clinical cases confirm the effectiveness of rehydration, cytomucoprotective and probiotic therapy for infectious diarrhea, regardless of the etiology, including COVID-19. Conclusions. Diarrhoea and other symptoms of gastrointestinal disorders in COVID-19 are stopped when pathogenetic therapy is recommended for patients with acute intestinal infections. © 2020, Remedium Group Ltd. All rights reserved.

Gastrointestinal tract disorders in COVID-19 infected children

Objective of the work was to investigate the peculiarities of gastrointestinal tract disorders in children with coronavirus disease caused by SARS-CoV-2 virus. Materials and methods. We have analyzed the frequency, terms of emergence, duration and character of gastrointestinal disorders on the basis of medical records of 36 children receiving the treatment for community-acquired pneumonia of coronavirus etiology (positive for SARS-CoV-2 virus) in the children’s infectious disease department of Moscow State Clinical Hospital, Mytishchi. The majority of patients had moderate form of the disease (97 %), severe cases were not registered. The age range of the children – 8 months to17 years old. All patients were subjected to supplementary examination on Day 1 in accordance with the current recommendations. Children were treated in hospital settings for 8–15 days. Assessment of clinical status was performed at least once a day over the stated period, supplementary survey – at least once in a week, upon indications – more frequently. SARSCoV-2 virus was identified using polymerase chain reaction. All patients received standard therapy in compliance with advanced methodological recommendations, upon indications – other pharmaceutical products. Results and discussion. Gastro-intestinal disorders in 23 children (64 %) emerged on Day 4–5, in 8 children (22 %) – before the start of the treatment;they lasted 3–5 days. In most of the patients diarrhea (64 %) and stomachaches (57 %) were observed. 67 % of the children demonstrated other symptoms indicative of gastrointestinal dysfunction. The disorders were characteristic for most of the children hospitalized with community-acquired pneumonia caused by SARS-CoV-2 virus. The symptoms are contained when the main course of therapy is conducted, indicated for treatment of COVID-19, and additional therapy recommended for management of gastro-intestinal infections is performed. © 2020 Russian Research Anti-Plague Institute. All rights reserved.