[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.

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.

[COVID-19: new challenges for medical science and practical health].

Currently, due to the wide spread of the new coronavirus infection COVID-19 and the need for anti-epidemic measures, medical science should integrate all efforts to ensure, on the one hand, at the global level - the fight against the spread of infection, on the other hand, at the individual level - increasing the adaptive capacity and immune response of the organism to protect against COVID-19. Nutrition is the most important factor determining human health and the functioning of all mechanisms to protect a person from negative environmental factors. For the prevention and treatment of new coronavirus infection COVID-19, a significant role is played by the correction of eating disorders, including vitamin and micronutrient deficiency. Federal Research Centre of Nutrition and Biotechnology, together with Russian Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing (Rospotrebnadzor), prepared Recommendations on nutrition for children and adults, requiring a self-isolation regime or quarantine at home in connection with COVID-19. In order to promptly inform and advise the population on nutrition optimization in the early days of anti-epidemic measures, an information reference Contact Center was created and is continuously functioning on the basis of the Federal Research Centre of Nutrition and Biotechnology. Equally important is the implementation of measures aimed at the prevention of food contamination with COVID-19 agent. In this regard, the Federal Research Centre of Nutrition and Biotechnology, together with Rospotrebnadzor prepared guidelines on measures to prevent the transmission of a new coronavirus infection through foods. Another aspect that the medical community has faced in connection with the pandemic is the need to reorient specialized medical organizations that have not previously worked with patients with infectious diseases in order to create Clinical centers for the treatment of the new coronavirus infection COVID-19. Thus, in the context of the spread of the new coronavirus infection COVID-19, many areas of medicine are involved in the process of providing anti-epidemic measures. Successful completion of the tasks will significantly reduce the negative consequences of the COVID-19 pandemic for the state and citizens.