Surgical treatment of acute intestinal obstruction in the infectious department environment for covid-19 patients.

Surgical care in a mono-hospital for patients with COVID-19 leads to a number of organisational problems due to the lack of specialised departments. The article presents the experience of surgical treatment in a mono-hospital obtained from one and a half years of work in this mode. In total, approximately 400 surgeries were performed. The experience of treatment of 7 patients with acute intestinal obstruction has been summarised. In the abdominal cavity, a significant number of hematomas of varied localisation were found under the parietal and visceral peritoneum, as well as in the subcutaneous fat. This is possibly associated with anticoagulant therapy included in the treatment regimen for patients with COVID-19 according to the methodical recommendations by the Ministry of Health of the Russian Federation. As an illustration, a successful case of treating COVID-19 patient with strangulated hernia of the abdominal white line complicated by acute intestinal obstruction is presented.Copyright © 2022, Krasnoyarsk State Medical University. All rights reserved.

Predictors of lethal outcomes in severe cases of a new coronavirus infection COVID-19

Background. The spread of the new coronavirus infection COVID-19 has already become one of the main problems of national healthcare systems around the world. Until now, it has not been possible to find drugs with sufficient etiotropic activity for COVID-19, and therefore, it is important to determine new points of application for pathogenetic therapy in relation to this pathology. Aim. To identify the predictors of an unfavorable outcome of a severe course of COVID-19 infection to determine the prognosis of the clinical course and optimize treatment tactics using succinates. Material and methods. A retrospective observational study of 46 cases of treatment with a severe form of the disease on the basis of a monohospital for the treatment of patients with a new coronavirus infection was conducted. All patients had comobrid pathology (median Charlson index - 3 points). The most common ones were: encephalopathy of mixed genesis, diabetes mellitus, coronary heart disease, arterial hypertension, alimentary-constitutional obesity. We assessed the relationship between indicators of initial status and mortality in patients, and indicators with a statistically significant relationship were selected as predictors. Statistical processing of the results was carried out in the IBM SPSS v. 23.0, ROC analysis was used to find the relationship between quantitative predictors and lethal outcome. Results. Among the treated parameters, the most significant influence on the risk of death was found in arterial anion gap (odds ratio 28.78;p <0.017) and fibrinogen level (odds ratio 22.20;p <0.01). To a lesser extent, the level of urea, aspartate aminotransferase, and the Charlson comorbidity index had an effect on the prognosis of a lethal outcome. The identified predictors of an unfavorable outcome of a severe course of COVID-19 infection can be used to predict the clinical course and build treatment tactics based on the received information. Conclusion. Predictors of poor outcomes in severe COVID-19 infections include arterial anion gap and fibrinogen levels, and to a lesser extent, urea levels, aspartate aminotransferase levels, and the Charlson comorbidity index. © Eco-Vector, 2023. All rights reserved.

Changes in the State of Vital Systems with Long COVID-19

—Long COVID-19 is a chronic disease that continues to be studied. Data on epidemiology and the main symptoms typical for long COVID-19 are presented. Issues related to the pathogenesis of the disease are discussed. At the same time, special attention is paid to the inflammation process (including of the vascular wall endothelium), the state of the immune system (cytokine storm), the hemostasis system (the mechanism for the development of microangiopathy and thrombosis), and oxidative stress. During the analysis, a special place is given to central nervous system disorders (including organic brain damage) and disorders of cognitive functions. In addition, currently known complications from the cardiovascular system and respiratory organs are described. The treatment and rehabilitation of patients with long COVID-19 is not only a medical, but also a significant social problem.

Hemodynamic Parameters After Prone Positioning of COVID-19 Patients

Aim of the study. To examine the effect of prone positioning on hemodynamics in patients with COVID-19. Materials and methods. The study enrolled 84 patients of both sexes with community-acquired multiseg-mental viral and bacterial pneumonia associated with COVID-19, who were divided into groups according to the type of respiratory support. The tests were performed using the integrated hardware and software system for noninvasive central hemodynamic assessment by volumetric compression oscillometry. Results. We found that the pulse blood pressure velocity decreased from 281 [242.0;314.0] to 252 [209;304] mm Hg/s in patients with severe COVID-19 on oxygen support (p=0.005);volume ejection rate decreased from 251 [200;294] to 226 [186;260] ml/s (P=0.03);actual/estimated normalized vascular resistance ratio dropped from 0.549 [0.400;0.700] to 0.450 [0.300;0.600] (P=0.002), while the arterial wall compliance increased from 1.37 [1.28;1.67] to 1.45[1.10;1.60] ml/mm Hg (P=0.009). Prone positioning of patients on noninvasive lung ventilation associated with a reduction of linear blood flow rate from 40.0 [34.0;42.0] to 42.5 [42.5;47.25] cm/s (P=0.04) and arterial wall compliance from 1.4 [1.24;1.50] to 1.32 [1.14;1.49] ml/mm Hg (P=0.03). Prone positioning of patients on invasive lung ventilation did not result in significant hemodynamic changes. Conclusion. The greatest hemodynamic changes during prone positioning were found in patients on oxygen respiratory support, whereas the least significant alterations were seen in patients on invasive ventilatory support. Copyright © 2021, V.A. Negovsky Research Institute of General Reanimatology. All rights reserved.

Platelets, leukocytes and their ratio as predictors of outcomes in patients with COVID-19

Background. Identification of easily accessible and most accurate predictors of favorable and fatal outcomes in COVID-19 is of great importance, as it allows timely correction of the patient’s treatment tactics. Objective: to develop predictors based on a general blood test that allow to predict COVID-19 outcome at relatively early stages. Patients/Methods. We examined 125 patients with severe and extremely severe course of COVID-19, in whom the number of platelets, leukocytes, their fractions and ratios were determined on days 1, 5, 7, 10, 14 and 21 of hospital stay. ROC-analysis was performed to calculate survival and lethality thresholds having predictive value. Results. It was found that the most accurate predictive parameters of COVID-19 outcome were leukocyte total number and ratios platelets/leukocytes, platelets/neutrophils, neutrophils/lymphocytes, neutrophils/monocytes. At the same time neutrophils/lymphocytes ratio can be considered the most accurate test for predicting COVID-19 outcome, that according to the expert scale with a “good” rating already at days 5 and 7, and with an “excellent” rating at days 10, 14 and 21 allow to conclude about the possible outcome of the pathological process. However, clinically valuable is the coincidence of predic-tions of COVID-19 outcome for 2–3 or more parameters. Conclusions. Neutrophils/lymphocytes ratio is the most accurate predictor of COVID-19 outcome. Total leukocyte count and platelet/leukocyte, platelet/neutrophil, neutrophil/lymphocyte, and neutrophil/ monocyte ratios are additional predictors of COVID-19 outcome. Timely correction of the identified shifts in the content of platelets, leukocytes and their fractions, as well as their ratios, seems to be a perspective direction in the pathogenetic therapy of COVID-19. © 2022, Hemostasis and Rheology LLC.

[Morphological compound and indicators of the blood clotting system in severe COVID-19 patients of middle aged and elderly during treatment of Tocilizumab and Thymalin.]

The aim of the work was a comparative study of Tocilizumab and Thymalin effects on the morphological composition and indicators of the blood clotting system in COVID-19 of middle aged and elderly patients. Severe COVID-19 patients were divided into 3 groups: 1st - control (basic therapy), 2nd - basic therapy +Tocilizumab, 3rd - basic therapy +Thymalin. Hospital mortality in COVID-19 patients after standard therapy, Tocilizumab and Thymalin application was 40,9;28,4 and 20,6% accordingly. The number of platelets increased by 1,5 times, the concentration of fibrinogen in blood decreased by 78% and activated partial thromboplastin time decreased by 9,3% in patients taking Tocilizumab. Under the influence of Tocilizumab, the platelet/white blood cell and platelet/lymphocyte ratios increased by 1,6 and 1,4 times, which may be a predictor of an unfavorable outcome of COVID-19. Thymalin increased the number of lymphocytes and monocytes by 2 times, the number of leukocytes - by 1,3 times, the number of platelets in the blood - by 1,5 times. Thymain decreased the platelet/lymphocyte and neutrophil/lymphocyte ratios by 1,4 times and 2 times. The use of Thymalin decreased the level of fibrinogen, lactate dehydrogenase and D-dimer in the blood by 1,2;1,8 and 1,7 times, respectively. Thymalin, compared with Tocilizumab, meets the principles of pathogenic therapy for severe COVID-19 of middle aged and elderly patients to a greater extent, having a normalizing effect on the morphological composition and indicators of the blood clotting system.

Surgical treatment of acute intestinal obstruction in the infectious department environment for covid-19 patients

Surgical care in a mono-hospital for patients with COVID-19 leads to a number of organisational problems due to the lack of specialised departments. The article presents the experience of surgical treatment in a mono-hospital obtained from one and a half years of work in this mode. In total, approximately 400 surgeries were performed. The experience of treatment of 7 patients with acute intestinal obstruction has been summarised. In the abdominal cavity, a significant number of hematomas of varied localisation were found under the parietal and visceral peritoneum, as well as in the subcutaneous fat. This is possibly associated with anticoagulant therapy included in the treatment regimen for patients with COVID-19 according to the methodical recommendations by the Ministry of Health of the Russian Federation. As an illustration, a successful case of treating COVID-19 patient with strangulated hernia of the abdominal white line complicated by acute intestinal obstruction is presented. © 2022, Krasnoyarsk State Medical University. All rights reserved.

Changes in Some Vascular Biomarkers in Patients with Severe COVID-19 with Various Degrees of Pulmonary Hypertension.

The aim of the study was to evaluate the levels of cardiac biomarkers endothelin 1, B-natriuretic peptide (BNP), N-terminal pro-B-type natriuretic peptide (Nt-proBNP), NO2, and NO3 in patients with COVID-19 pneumonia and various degrees of pulmonary hypertension. Group 1 included patients with pulmonary artery systolic pressure <25 mm Hg, group 2 with 25-40 mm Hg, and group 3 with 40-60 mm Hg. In the group of patients with pulmonary artery systolic pressure <25 mm Hg, the level of NT-proBNP was higher than in the rest two groups by 41.3% (p=0.015) and 38.2% (p=0.015), respectively. The levels of nitrites and nitrates in group 1 patients were lower: NO2 was reduced by 31.1% (p=0.026) and 62.8% (p=0.008), and NO3 was reduced by 28% (p=0.029) and by 54.6% (p=0.006), respectively. No other changes in the parameters in patients receiving oxygen therapy were found. These findings suggest that severe course of COVID-19 in patients with severe pulmonary hypertension is associated with impaired nitrite and nitrate metabolism and reduced levels of Nt-proBNP.

Neuroprotective Therapy for Neurological Complications of the Novel Coronavirus Infection COVID-19

COVID-19 is a global contemporary issue. Acute hypoxic respiratory failure and associated multiple organ dysfunction are the basics of the new disease pathogenesis. An important characteristic of COVID-19 is the damage to the central nervous system, which determines the peculiarities of the clinical course. In the case of vascular complications (ischemic stroke, encephalopathy, delirium) the prognosis of the disease is more severe. The article presents the experience of a large Russian monohospital in observation and treatment of patients with COVID-19 and neurological complications. It also shows the prospect of neuroprotective therapy in this category of patients.

BLOOD CIRCULATION CHANGES ASSOCIATED WITH SWITCHING TO NON-INVASIVE VENTILATION IN COVID-19 PATIENT

Background. Various methods of respiratory support in combination with prone positioning have been used during the COVID-19 pandemic. The effects of combination of these two factors on hemodynamics are of interest for clinical practitioners. The aim: to evaluate the effect of prone positioning on hemodynamics in COVID-19 patients depending on the method of respiratory support. Materials and methods. The study included 17 patients of both sexes diagnosed with COVID-19-associated community-acquired polysegmental viral and bacterial pneumonia with progressive respiratory failure. The study consisted of two stages. During the first stage, the patients were receiving respiratory support with humidified oxygen (3-7 liters per minute). The second stage was initiated after switching to noninvasive ventilation (NIV). The measurements were performed using a technique of volumetric compression oscillometry on a non-invasive hemodynamic monitoring system KAP CGosm-Globus (Russia). Results. The study showed that prone positioning in patients with severe COVID-19 when switching from oxygen therapy to NIV resulted in a change in the diastolic blood pressure difference module from 2.5 (1.0;8.2) to 8.0 (5.7;14.0) (p = 0.016). Escalation of respiratory support led to the changes in the left ventricular outflow tract velocity difference module from 11.5 (9.5;34.2) to 31.0 (15.7;42.0) (p = 0.049). Conclusions. Patients with community-acquired polysegmental viral and bacterial pneumonia associated with COVID-19 demonstrated changes in diastolic blood pressure and left ventricular outflow tract velocity as a result of prone positioning following switching from oxygen therapy to NIV. © 2021 Scientific Centre for Family Health and Human Reproduction Problems. All rights reserved.

HEART RATE VARIABILITY IN PATIENTS WITH MODERATE AND SEVERE COVID-19

The study of heart rate variability (HRV) in COVID-19 is of undoubted interest, as it allows one to judge about disturbances in the work of the cardiovascular system, as well as about shifts in the state of autonomic regulation of physiological functions. Both of these systems are targets for viral damage. The aim. To investigate how HRV changes in seriously ill COVID-19 depending on the severity of the disease, as well as to determine the prognostic role of ROC analysis in predicting the outcome of the pathological process. Materials and methods. observations were carried out on 29 patients of moderate severity (age 58.7 +/- 6.5 years), and 55 seriously ill (59.4 +/- 9.2 years) COVID-19. The control group consisted of 69 people (mean age 62.5 +/- 9.6). HRV was studied using the Rehovot Dynamic Light Scattering apparatus (Israel) and using an original algorithmic approach. Statistical processing was performed using the R language version 3.6.2. To assess the relationship between the studied indicators, the Pearson correlation method was applied. To calculate the threshold values for survival and mortality, which have predictive value, an ROC analysis was performed. Results. In patients with COVID-19, HRV parameters significantly decreased. There were no significant differences in the studied values between groups of different severity. The data obtained indicate a violation of the activity of both the sympathetic and parasympathetic divisions of the autonomic nervous system. ROC analysis of HRV did not provide a predictive model for COVID-19 with a high probability of an outcome. Conclusion. In patients with moderate and severe COVID-19, the main indicators of HRV are significantly reduced. Using ROC analysis of HRV, no significant predictors of favorable and fatal outcomes were found in patients with COVID-19.

The State of Microcirculatory Hemodynamics in Patients with Moderate and Severe COVID-19.

Microcirculatory hemodynamic indexes (HI) were assessed in patients with moderate and severe COVID-19. In both groups, a significant increase in the absolute spectral indexes (HI1, HI2, and HI3) and the ratio of low-frequency to high-frequency component (HI1/HI3) was revealed. In the group of severe infection, only the "slow" index (low-frequency HI1) of microcirculatory hemodynamics was significantly lower. The oscillatory indices MAYER1-3 and RESP1-3 were reduced in patients of both groups. The aggravation of the disease course was accompanied by depression of the low-frequency index HI1. Regulatory shifts compensate for disturbances in microcirculatory processes in moderate COVID-19, but severe course was associated with their decompensation.

COVID-19 in pregnant and non-pregnant women of early reproductive age

Aim. To identify confounding factors, features of the clinical course and outcomes of COVID-19 in pregnant and non-pregnant patients of early reproductive age who have no known risk factors and premorbid background. Materials and methods. The study included 163 pregnant women in the third trimester of gestation, 100 non-pregnant women with laboratory-confirmed SARS-CoV-2 infection and 100 pregnant women who did not get sick. Patients of all groups were comparable in age (18-35 years), social status, parity, body mass index, had no known risk factors for COVID-19;those who got sick were treated simultaneously. Results. Statistically significant associations were revealed between COVID-19 infection in the pregnant and iron deficiency anemia, vegetovascular dystonia, belonging to the Buryat ethnicity, and smoking. Pregnant women with COVID-19 were more likely to have no symptoms (23.3% vs 5%;p<0.001) or had a mild course of the disease (58.9% vs 24%;p<0.001). In non-pregnant patients, the course of infection was more often moderate (61% vs 14.7%;p<0.001) or severe (10% vs 3.1%;p=0.038). Clinical manifestations of new coronavirus infection (NCV) in pregnant women were dominated by anosmia (87.7% vs 40%;p<0.001), drowsiness (68.7% vs 17%;p<0.001), dyspnea, even with a mild lung lesion (68.1% vs 19%;p<0.001), headache (41.7% vs 24%;p=0.006), arthralgia (29.4% vs 16%;p=0.021), while fever above 38 °C (7.4% vs 28%;p<0.001) and cough (38.7% vs 61%;p<0.001) were much less common. With computed tomography, pneumonia in pregnant women was diagnosed several times less often (21.4% vs 87.4%;p<0.001). In the non-pregnant group, there was one death (1% vs 0%;p=0.201) associated with late hospitalization for severe NCI with grade 4 pulmonary involvement as shown on computed tomography. Conclusion. Confounders of COVID-19 in pregnant women who have no known risk factors in the third trimester of gestation are iron deficiency anemia, vegetovascular dystonia, belonging to the Buryat subpopulation, and smoking. In pregnant women, the main clinical symptoms of SARS-CoV-2 infection, with the exception of loss of smell, were nonspecific and characteristic of the physiological course of late gestation: drowsiness, dyspnea, joint pain. The predominance of mild or asymptomatic forms of infection, the lower incidence of pneumonia, and the absence of deaths in pregnant women suggests a more favorable course of COVID-19 NCI. © 2021 Consilium Medikum. All rights reserved.

[Surgical procedures at the city hospital for patients with Covid-19. A 9-month experience]. / Khirurgicheskie vmeshatel'stva v gorodskoi bol'nitse v period ee deyatel'nosti v kachestve monostatsionara dlya patsientov s Covid-19. Devyatimesyachnyi opyt.

OBJECTIVE: To report our experience in surgical treatment of patients with COVID-19. MATERIAL AND METHODS: There were 7815 patients with COVID-19 for the period from April 1, 2020 to December 31, 2020. During this period, 172 operations were performed in this group. RESULTS: The most common procedures were tracheostomy (n=86, 50.0%), pleural puncture and drainage (n=20, 11.6%), caesarean section (n=22, 12.7%). There were 24 (14.0%) abdominal surgeries including 11 laparoscopies, 5 appendectomies, 3 bowel resections and others. Six lower limb amputations were carried out. We should emphasize common soft tissue hematomas and effusions. This complication is associated with anticoagulation recommended for patients with COVID-19. CONCLUSION: Surgical interventions using personal protective equipment is a significant challenge. According to our experience, round-the-clock surgical care in a specialized hospital is required.

Three-month results of vaccination of mono-stationary health workers with the drug «Gam-COVID-Vac»

Introduction. Antibodies are considered as a key immune effectors that provide protection against pathogenic threats. At the same time, the nature and duration of the antibody response to SARS-CoV-2 infection has not been precisely determined. The aim of the study was to determine the changes in the level of antibodies to SARSCoV-2 during immunization with the «Gam-COVID-Vac» vaccine. Material and methods. Observations were carried out with participance of 30 employees of the city clinical hospital No. 1. Medical workers were vaccinated against COVID-19 with the «Gam-COVID-Vac» vaccine according to the standard scheme. The level of antibodies was assessed on the 17th day after the administration of the 1st component of the vaccine, on the 17th and 30th days after the administration of the 2nd component of the vaccine. Results. Our studies show that the blood level of IgM antibodies to SARS-CoV-2 practically did not change on the 17th and 38th days after immunization with the 1st component (the average СP values were 1.616 and 1.75, respectively). However, by the 30th day, a decrease of IgM to SARS-CoV-2 was observed (average СP value - 0.7829). It should be noted that on the 17th day after immunization a significant variation was revealed in its indicators, which leveled off by the 30th day. A completely different picture was observed with the level of IgG antibodies to SARS-CoV-2. It significantly increased after immunization with the 2nd component and did not change until the 30th day (the average CP values were 12.36 and 12.48 on the 38th and 51st days, respectively). It is necessary to pay attention to the fact that after immunization with the 1st component on the 17th day, a low level of IgG to SARS-CoV-2 (CP - < 1) was recorded in 48 %, and after immunization with the 2nd component - only in 10 % vaccinated. At the same time by 51 days from vaccination the seroconversion level was 100 %. It should be noted that in some patients the IgG level changed by the 30th day after immunization, compared to the 17th day. Conclusion. Thus, our information confirms that the «Gam-COVID-Vac» vaccine is effective and, in more than 90 % of cases, leads to the formation of a sufficiently high level of antibodies against SARS-CoV-2.

The level of satisfaction with their work and degree of burnout among anesthesiologists and emergency physicians working in the red zone of a COVID hospital

The objective: To determine the level of satisfaction with their work and degree of burnout among anesthesiologists and emergency physicians working in the red zone of a COVID-19 hospital. Subjects and methods. A prospective study was conducted as an anonymous survey of physicians performing their duties in intensive care units of the red zone. 65 specialists were interviewed: Group 1 (52.3%) trainee physicians, Group 2 (47.7%) anesthesiologists and emergency physicians. Results. The majority of respondents in both groups noted relatively high satisfaction with their current work. At the same time, the majority of respondents (70.9%) in the group of anesthesiologists and emergency physicians would prefer the previous working conditions to current ones. Also, it was noted that both groups were highly emotionally exhausted. © 2020 Geocarrefour. All rights reserved.

Current issues of labor protection of anesthesiologists and intensice care specialists under new coronavirus infection

The labor activity of anesthesiologists and intensive care specialists has undergone significant changes in 2020. Admission of a large number of patients with a new coronavirus infection was accompanied by increased workload, changes in working and rest condi-tions, as well as new risks to the life and health of medical employee. A complex of measures to support healthcare professionals was adopted in the Russian Federation. Awareness of staff about these measures is the most important factor for effective health-care system functioning under a new coronavirus infection. © 2021, Media Sphera. All rights reserved.

Prospects for the Use of Succinates in Treating Severe Course of New Coronavirus Infection

A global problem of humankind in 2020 is the provision of medical care to patients with the new coronavirus infection COVID-19. On the background of unsatisfactory results of studies of the effectiveness of existing antiviral drugs, pathogenetic therapy is of particular importance. As a rule, patients with severe forms of COVID-19 suffer from chronic comorbidities, the exacerbation of which is often the leading cause of poor outcome. The purpose of this work is to analyze the clinical practice of using drugs based on succinates (succinic acid salts) in the treatment of severe forms of COVID-19. A retrospective continuous study of treatment regimens in a group of 223patients with severe forms of COVID-19 showed that about 27% of patients received metabolic drugs containing succinate as one of the active components. Main indications for the prescription of drugs were concomitant and background diseases such as ischemic heart disease, decompensation of diabetes mellitus, discirculatory encephalopathy, and asthenia. In this case, Reamberin (detoxifying agent) was used on the average for 4.8 days (from 2 to 11), Remaxol (hepatoprotective agent) for 6.5 days (from 1 to 18), and Cytoflavin (neuroprotective agent) for 5.7 days (from 2 to 10). The expediency of conducting prospective randomized clinical trials of the effectiveness of including succinate-containing drugs in the therapy regimens for patients with severe forms of COVID-19 in order to improve the quality of medical care provided to this category of patients has been established. Глобальная проблема человечества в 2020 г. - оказание медицинской помощи пациентам с новой коронавирусной инфекцией COVID-19. На фоне неудовлетворительных результатов исследований эффективности противовирусных препаратов особое значение приобретает патогенетическая терапия. Как правило, пациенты с тяжелыми формами COVID-19 страдают хроническими сопутствующими заболеваниями, обострение которых нередко является ведущей причиной неблагоприятного исхода. Цель работы - анализ клинической практики применения лекарственных препаратов на основе сукцинатов (солей янтарной кислоты) при лечении тяжелых форм COVID-19. Ретроспективное исследование схем терапии пациентов (223) с тяжелыми формами COVID-19 показало, что около 27 % пациентов получали лекарственные препараты метаболического действия, содержащие сукцинат в качестве одного из активных компонентов. Основными показаниями для назначения являлись сопутствующие заболевания: ишемическая болезнь сердца, декомпенсация сахарного диабета, дисциркуляторная энцефалопатия, астения. При этом реамберин (дезинтоксикационное средство) применяли в среднем 4,8 дня (от 2 до 11), ремаксол (гепатопротективное средство) - 6,5 дня (от 1 до 18), цитофлавин (нейропротективное средство) - 5,7 дня (от 2 до 10). Установлена целесообразность проведения проспективных рандомизированных клинических исследований эффективности включения сукцинатсодержащих препаратов в схемы терапии пациентов с тяжелыми формами COVID-19 c целью повышения качества медицинской помощи, оказываемой данной категории больных.