COVID-19 pandemic: Practical advice for Endoscopy Units. Mistakes to be avoided. Experience of the Italian North-Eastern Venetian Region.

Italy is the second most affected by coronavirus epidemy country in the world. In this article, members of the Italian Society of Surgical Endoscopy analyze the work of endoscopic units during the COVID-19 pandemic. Authors explain how to stratify patients according to risk groups, how to put on and off personal protective equipment, list decontamination standards for endoscopic equipment and endoscopic room.Copyright © 2020, Media Sphera Publishing Group. All rights reserved.

Coronavirus (COVID-19): control and prevention in endoscopy department.

Currently, the number of people infected with novel coronavirus infection (COVID-19) worldwide is growing exponentially, which requires immediate measures to prevent its spread. Endoscopy departments are at daily risk of spreading aerosol-transmissible viruses. This review highlights actions that are necessary to prevent further spread of COVID-19 infection in endoscopy departments. All recommendations are approved by the Scientific Expert Council of the Moscow Department of Health (Protocol No. 2 03/05/2020).Copyright © 2020, Media Sphera Publishing Group. All rights reserved.

COVID-19 and its influence on gastroenterology and endoscopy.

This article provides a short overview of the impact of the COVID-19 on gastroenterology and endoscopy. The healthcare worker's and scientists' selfless work helped to accumulate in a short period a large amount of information that helped to fight the new infection and its consequences. As clinicians, we need to continually renew information and promptly change clinical practice based on evidence-based medicine principles.Copyright © 2020, Media Sphera Publishing Group. All rights reserved.

Evaluation of diarrhea in COVID-19 patients

Diarrhea in COVID-19 patients can be due to SARS-CoV-2 direct damage of the colon mucosa or antibiotic-associated diarrhea (AAD), in particular Clostridioides difficile infection (CDI). Objective. To determine the incidence of diarrhea and its epidemiological and clinical features in patients with COVID-19. Material and methods. The study included 200 patients with confirmed COVID-19 hospitalized at the Central Clinical Hospital from March 2020 to July 2021. Results. Diarrhea developed in 61 (30.5%) patients. AAD was detected in 36 (59%), CDI in 15 (24.6%), diarrhea associated with SARS-CoV-2 in 6 (9.8%) patients. 77% of patients had mild diarrhea. The detection of C. difficile toxins is associated with a severe course of the disease (OR=4.38 [95% CI: 1.41—13.13];p=0.0085) and longer length of stay — 21 [16.5—27, 8] (p<0.0001). Detection C. difficile toxins increased by 5.6% in 2020 compared to 2019 [95% CI: 2.7—8.5, (p=0.0003)]. 46.7% were diagnosed with recurrent CDI within a year after discharge from the hospital. The most reliable indicators of diarrhea severity are CRP, calprotectin, and albumin. The bowel wall thickness on ultrasound in patients with mild diarrhea was <0.4 cm;in patients with severe and moderate diarrhea 0.6—1 cm. Conclusions. Diarrhea caused by SARS-CoV-2 is mild and is associated with a more favorable outcome, while CDI is associated with more severe disease. There is an increase in the incidence of CDI in the post-COVID period. According to our data, calprotectin and bowel wall thickness on US can be used as diarrhea severity indicators. © 2022, Media Sphera Publishing Group. All rights reserved.

Analysis of the first fatal outcome cases of a new coronavirus infection covid-19 in medical organizations of the state healthcare system of Moscow

COVID-19 posed a new challenge to the global medical science, and not all traditional approaches used earlier, for example, in the treatment of SARS and other viral infections, were acceptable. On March 20, 2020, the first fatal outcome from a new coro-navirus infection was registered in Moscow. By the time the article was published (6 weeks later) more than 1000 deaths were reg-istered. Taking into account the fact that there is still a growth in the number of patients and, consequently, deaths, the analysis of lethal outcomes of the first (in chronological order of patients) seems to be extremely relevant. As information about a new coro-navirus infection accumulates, our actions and recommendations on its treatment will change. Most drugs to treat the new coro-navirus infection are still under clinical trials. A vaccine has not been developed, and data on the use of plasma, convalescents, hydroxychloroquine and a number of other drugs are insufficient to provide recommendations that meet the principles of evidence-based medicine. We believe that the analysis of the first 157 fatal cases of a new coronavirus infection is only the first step in the for-mation of carefully verified treatment recommendations. © 2020, Media Sphera Publishing Group. All rights reserved.

Hydroxychloroquine: The story of one drug during the COVID-19 pandemic

The new coronavirus (SARS-CoV-2) poses a serious threat to public health worldwide. From the moment of its finding to the present, the incidence of new cases is only increasing. So far, no drugs were proven to have antiviral activity in clinical practice. Many drugs have already gone a path from in vitro studies to randomized clinical trials in vivo. Objective. To review the literature on the use of hydroxychloroquine for the prevention and treatment of new coronavirus infection (COVID-19) for the period from the date of use until June 2020. © 2020, Media Sphera Publishing Group. All rights reserved.

Prediction of lethal outcomes in COVID-19 cases based on the results chest computed tomography

The objective: to predict lethal outcomes in patients with COVID-19 based on the result of chest computed tomography (chest CT) using a semi-quantitative visual scale of the pulmonary parenchyma lesion. Subjects and methods. Inclusion criteria: patients who underwent chest CT from March 2 to May 1, 2020, inclusively, upon referral of a general practitioner due to suspected community-acquired pneumonia caused by COVID-19. Chest CT was performed in 48 medical organizations providing primary medical care to the adult population in Moscow. Exclusion criteria: patients whose chest CT was not assessed by CT 0-4 score;patients who were not confirmed as COVID-19 positive. In the Russian Federation, CT 0-4 score is recommended to be used for assessment of the extent of lung parenchyma lesion in cases with suspected COVID-19. Data on fatal outcomes were received on May 4, 2020 inclusive. Results: data of 13,003 patients from the Unified Radiological Information Service were retrospectively included in the study according to inclusion and exclusion criteria. The test aimed to detect a trend of directional changes in the proportion of deceased patients among various categories using CT 0-4 score demonstrated a statistically significant result (p < 0.0001). The chance of a lethal outcome increases directionally from CT-0 to CT-4. The test for deviations from the linear trend also provided p < 0.0001, i.e. when moving to higher scores (CT-3 and CT-4), there was an accelerated increase in the risk of death. Analysis of overall survival using the Cox regression model showed that the assessed factors (age and CT 0-4 score) were statistically significantly associated with the time to death from COVID-19 (p < 0.05). The risk of death increased with age, on average, 8.6% for every 5 years (95% CI 0.8-17.0%). When transferring from one category of CT to the next one, the risk increased by 38% on the average (95% CI 17.1-62.6%). There was no statistically significant association of gender factor with overall survival (p = 0.408). The visual score of CT 0-4 recommended for use in the Russian Federation to assess lung parenchyma lesions according to chest CT data, is a predictor of a lethal outcome in patients with COVID-19. CT 0-4 score is convenient for practical use. Цель исследования: прогнозирование летальных исходов у больных COVID-19 по данным компьютерной томографии органов грудной клетки (КТ ОГК) с помощью полуколичественной визуальной шкалы степени поражения легочной паренхимы. Материалы и методы. Критерии включения: пациенты, которым с 2 марта по 1 мая 2020 г. включительно проведена КТ ОГК по направлению врача-терапевта с подозрением на внебольничную пневмонию, вызванную COVID-19. Эти исследования были выполнены в 48 медицинских организациях, оказывающих первичную медицинскую помощь взрослому населению в Москве. Критерии исключения: пациенты, у которых КТ ОГК не оценена по категориям шкалы «КТ 0-4»;пациенты, у которых COVID-19 не подтвердился. Шкала «КТ 0-4» рекомендована к применению в РФ для оценки объема поражения паренхимы легкого при подозрении на COVID-19. Данные о летальных исходах были получены на 4 мая 2020 г. включительно. Результаты: ретроспективно из Единого радиологического информационного сервиса на основании критериев включения и исключения для исследования отобраны данные 13 003 пациентов. Тест на наличие тенденции направленного изменения доли умерших пациентов среди различных категорий по шкале «КТ 0-4» дал статистически значимый результат (p < 0,0001). Вероятность летального исхода направленно увеличивается от «КТ-0» до «КТ-4». Тест на отклонения тренда от линейности также дал p < 0,0001, то есть при переходе к более высоким категориям («КТ-3» и «КТ-4») происходит ускорение прироста риска летального исхода. Анализ по общей выживаемости с помощью регрессионной модели Кокса показал, что оцениваемые факторы (возраст и категория по шкале «КТ 0-4») были статистически значимо ассоциированы со временем до наступления смерти от COVID-19 (p < 0,05). Риск смерти увеличивался с возрастом в среднем на 8,6% на каждые 5 лет (95%-ный ДИ 0,8-17,0%). При переходе из одной категории КТ в следующую риск увеличивался в среднем на 38% (95%-ный ДИ 17,1- 62,6%). Статистически значимой ассоциации фактора пола с общей выживаемостью не выявлено (p = 0,408). Визуальная шкала «КТ 0-4», рекомендованная в РФ для оценки поражения паренхимы легкого по данным КТ, является предиктором смерти у пациентов с COVID-19. Шкала «КТ 0-4» удобна для практического применения.

Interim guidelines: "Diseases of the digestive organs in the context of a new coronavirus infection pandemic (COVID-19)"

Consensus of experts of the Interregional Public Organization "Society of Gastroenterologists and Hepatologists "North-West", Russian Society for Prevention of Noncommunicable Diseases and the Profile Commission on Therapy and General Medical Practice of the Russian Ministry of Health. Консенсус экспертов Межрегиональной общественной организации «Общество гастроэнтерологов и гепатологов «Северо-Запад», Российского общества профилактики неинфекционных заболеваний и Профильной комиссии по терапии и общей врачебной практике Минздрава России.

[ENT care in the context of the new coronavirus infection COVID-19]. / Aktual'nye voprosy okazaniya spetsializirovannoi lor-pomoshchi v usloviyakh novoi koronavirusnoi infektsii COVID-19.

The spread of the pandemic of the new coronavirus infection COVID-19 inevitably makes adjustments to the medical care. Given that the main route of transmission is airborne, otorhinolaryngologists are at increased risk of infection. Based on the literature data of leading otorhinolaryngologists, as well as their own experience working with patients with the new coronavirus infection COVID-19, the authors present relevant recommendations on the organization of specialized otorhinolaryngological care in the context of the COVID-19 pandemic. The authors consider the etiology, pathogenesis, and clinical manifestations of COVID-19. The features of the examination of ENT, diagnostic and therapeutic procedures, including the use of silicone hydrotamps to stop the front and rear nose bleeds, developed in L.I. Sverzhevskiy OHRIM, and indications for hospitalization in the ENT hospital. Features of operations on the otorhinolaryngological profile during a COVID pandemic are also described. Summing up, the authors indicate that during the pandemic of the new coronavirus infection COVID-19, otorhinolaryngologists need to adhere to two fundamental principles aimed at preventing the spread of infection: the use of modern effective personal protective equipment and the use of examination methods (surgical treatment methods) that prevent the formation of biological aerosols.