СOURSE FEATURES OF A NEW CORONAVIRUS INFECTION IN A COMORBID PATIENT

The appearance of a new coronavirus infection (COVID-19) in 2020 caused by the SARS-CoV-2 virus set tasks for doctors of various specialties to quickly diagnose, treat, and develop effective rehabilitation measures. The medical community's knowledge about the respiratory tract lesions pathogenesis course in COVID-19 is going to improve, but the key accents placement in understanding this pathology course continues today. Suspected SARS-CoV-2 virus reference points are as follows: vascular endothelial dysfunction, coagulopathy, thrombosis resembling the antiphospholipid syndrome. Treatment is carried out in accordance with general recommendations aimed at the average patient despite the higher secondary infectious complications risk in patients suffering from cancer and a high severe COVID-19 risk. A successful inpatient treatment experience in patients suffering from comorbid pulmonary pathology and a new coronavirus infection is demonstrated on a separate example. The treatment duration and the complexity of selecting a rehabilitation measures course were due to the patient's history of central squamous cell lung cancer, surgical intervention (bilobectomy), radio- and chemotherapy, as well as complications in the form of pulmonary embolism. The concomitant respiratory pathology was differentiated (chronic obstructive pulmonary disease) during examination and treatment and basic therapy was selected, which made the medical rehabilitation stage more effective. The patient's condition required a more careful selection of combined anti-inflammatory, broncholytic, mucolytic, and antibacterial therapy than in patients without concomitant pathology. Treatment and a complex of rehabilitation measures, normalization of respiratory function, compensation for concomitant bronchopulmonary pathology was possible to be achieves as a result of the diagnosis of concomitant bronchopulmonary pathology. Careful diagnostic search and optimal treatment of all somatic pathology are important factors in the selection of adequate therapy for elderly patients suffering from coronavirus infection with comorbid pulmonary pathology. All rights reserved © Eco-Vector, 2022.

SOME FEATURES OF THE CORONAVIRUS INFECTION COURSE IN BRONCHIAL ASTHMA PATIENTS

The outbreak of a new coronavirus infection was officially recognized by the World Health Organization as a global pandemic since March 11, 2020. The pandemic is currently gradually receding, the number of patients is also steadily decreasing. However, these circumstances are not grounds to believe that the virus has been definitively and irrevocably defeated. For this reason, the world medical community is still concerned about the coronavirus' impact on the course and outcome of various chronic bronchopulmonary diseases. Bronchial asthma has been recognized as one of the leading forms of human somatic pathology throughout the history of mankind and medicine. It is quite natural that the focus of the researchers' attention turned out to be questions about the SARS-CoV-2 virus' impact on patients suffering from bronchial asthma, starting with the peculiarities of the course of combined pathology and ending with the peculiarities of therapy and subsequent rehabilitation. The issues of coronavirus infection and bronchial asthma pathogenesis were considered. The research data on some features of the development and course of a new coronavirus infection in patients with this profile were analyzed and summarized. The low coronavirus infection prevalence among patients with an allergic bronchial asthma form compared with other phenotypes is shown among such features, data on the effect of eosinophilia on the course of infection are presented, and the basic therapy's positive effect using inhaled glucocorticosteroids and/or monoclonal antibodies (biological therapy) in severe asthma, is shown in the form of a protective effect that provides a lighter coronavirus infection course. The main features of patient management suffering from bronchial asthma in the conditions of a pandemic are the organization of stable medical control in online telemedicine once monthly, regular examinations in accordance with the severity of the course of the disease and the correction of basic therapy to achieve complete control over the course of asthma. The article can be used under the CC BY-NC-ND 4.0 license © Authors, 2022.

Some features of the coronavirus infection course in bronchial asthma patients

The outbreak of a new coronavirus infection was officially recognized by the World Health Organization as a global pandemic since March 11, 2020. The pandemic is currently gradually receding, the number of patients is also steadily decreasing. However, these circumstances are not grounds to believe that the virus has been definitively and irrevocably defeated. For this reason, the world medical community is still concerned about the coronavirus' impact on the course and outcome of various chronic bronchopulmonary diseases. Bronchial asthma has been recognized as one of the leading forms of human somatic pathology throughout the history of mankind and medicine. It is quite natural that the focus of the researchers' attention turned out to be questions about the SARS-CoV-2 virus' impact on patients suffering from bronchial asthma, starting with the peculiarities of the course of combined pathology and ending with the peculiarities of therapy and subsequent rehabilitation. The issues of coronavirus infection and bronchial asthma pathogenesis were considered. The research data on some features of the development and course of a new coronavirus infection in patients with this profile were analyzed and summarized. The low coronavirus infection prevalence among patients with an allergic bronchial asthma form compared with other phenotypes is shown among such features, data on the effect of eosinophilia on the course of infection are presented, and the basic therapy's positive effect using inhaled glucocorticosteroids and/or monoclonal antibodies (biological therapy) in severe asthma, is shown in the form of a protective effect that provides a lighter coronavirus infection course. The main features of patient management suffering from bronchial asthma in the conditions of a pandemic are the organization of stable medical control in online telemedicine once monthly, regular examinations in accordance with the severity of the course of the disease and the correction of basic therapy to achieve complete control over the course of asthma.

Some features of the course of viral pneumonia in obesity

Intriduction. In the last decade, conflicting data has appeared that the presence of obesity in patients with several diseases not only does not worsen, but even improves their prognosis, which is called the “obesity paradox”. The role of elevated body mass index in patients with coronavirus pneumonia (COVID-19) remains unclear. Aim. To study the features of the course of pneumonia in young and middle-aged men depending on the body mass index. Materials and methods. A retrospective analysis has investigated and it included 451 young and middle-aged men who underwent inpatient treatment for COVID-19 pneumonia. Patients were randomized according to body mass index into groups: normal nutrition (N), overnutrition (On), obesity (Ob). Clinical and laboratory parameters were assessed using statistical analysis. Results and discussion. In patients with obesity, the causative agent of pneumonia was detected in 91.9% of cases, in contrast to group N (65.75%). At the onset of pneumonia, group Ob differed significantly from group N in terms of erythrocyte sedimentation rate (17 versus 9 mm/h), C-reactive protein (18.3 versus 7.2 mg/l), D-dimer (304 versus 230 ng/ml), glycemia (6.2 versus 5.2 mmol/l), lymphocytes 9 (1.3 versus 1.5 × 109/l). In the dynamics in the group Ob, in comparison with the group N, there is a higher level of platelets (307 versus 1 × 109/l), neutrophils (6.3 versus 3.7 × 109/l), monocytes (0.8 versus 0.6 × 109/l) and a smaller number of lymphocytes (1.4 versus 2.0 × 109/l). It was revealed that the lymphocytic index and the index of the ratio of lymphocytes to monocytes in dynamics significantly increase in group N (from 0.5 to 0.7 and from 3.5 to 4.5, respectively), in group On only the lymphocyte index significantly increases (from 0.4 to 0.5), in the obesity group they do not change (from 0.4 to 0.5 and 3 from.0 to 2.7, respectively). The greatest need for respiratory support had group Ob (21.1%) in comparison with GNP (6.0%). Conclusions. The level of adipose tissue in the body has a direct impact on the course of pneumonia. © 2022, Remedium Group Ltd. All rights reserved.

Factors affecting the content of IgG-antibodies to S-protein SARS-CoV-2 in the blood of reconvalescents after new coronaviral infection (COVID-19)

Introduction. Morbidity and mortality of COVID-19 actualizes the identification of groups with the greatest risk of primary and re-infection, persons in need of priority vaccination or revaccination. Objective. To study the factors affecting the content of IgG antibodies to the S-protein SARS-CoV-2 in convalescents after suffering COVID-19 for 6 months Materials and methods. The study of the Military Medical Academy and the Helix Laboratory Service was carried out from 06/01/2020 to 08/01/2021 on the basis of the Military Medical Academy and the Helix centers. The study included 1421 people – both sexes from 18 to 70 years old. 1205 with asymptomatic and mild disease (outpatient group). 216 with moderate or severe form (inpatient group). The outpatient group underwent a quantitative determination of IgG to the spike (S) protein SARS-CoV-2 by immunochemiluminescence analysis at 30, 45, 60, 90, 180 days from diagnosis. The diagnosis was verified by a positive RT-PCR result. The inpatient group underwent an identical study on the 1st, 14th, 45th, 60th, 90th and 180th days from the moment of admission to the hospital. The diagnosis was verified in the same way. Results. In convalescents, post-infectious immunity is formed from 30 days. Older age was associated with a more pronounced production of IgG to the S-protein SARS-CoV-2, mainly in older women. Moderate and severe course is characterized by higher concentrations of IgG to the SARS-CoV-2 S protein. a high level of IgG to the S-protein SARS-CoV-2 persists for up to 90 days, with a subsequent decrease by 180 days. Body weight, days of oxygen therapy, hyperthermia, the volume of lung tissue lesions and the level of C-reactive protein correlate with the concentration of IgG to the S-protein SARS-CoV-2. The use of glucocorticoids (GCS) is characterized by the presence of a higher concentration of IgG to the S-protein SARS-CoV-2 up to 6 months. There is a dose-dependent effect of using GCS. Conclusion. The formation and maintenance of the level of neutralizing antibodies for 6 months depends on the severity of the disease, the gender and age of the patients, and the fact of using GCS. This must be taken into account when carrying out therapeutic and preventive measures, planning vaccination. © 2022, Remedium Group Ltd. All rights reserved.

The role and place of glucocorticosteroids in treatment of covid-19 pneumonia without hypoxemia

Introduction. The article presents the problems of the use of glucocorticosteroids in the treatment of patients with coronavirus– associated pneumonia (COVID-19) without hypoxemia. The experience of the preemptive use of low doses of glucocorticosteroids in the treatment of such patients in a hospital is described. Simplification of a unified scheme of pathogenetic therapy with glucocorticosteroids in the above patients is urgent. The article highlights the effectiveness of the early use of low doses of glucocorticosteroids in the treatment of a specific cohort of patients with COVID-19. Objective. To assess the clinical efficacy and safety of early use of small doses of methylprednisolone in the comprehensive therapy of patients with moderate to severe COVID-19 pneumonia to prevent the development of complications and improve the outcomes of the disease. Materials and methods. The study included 40 hospitalized patients from 37 to 68 years (average age 52. years) with a diagnosis of moderate to severe COVID-19 pneumonia. Patients were randomized into two groups: The main group (n = 20) and the control group (n = 20). The main group additionally received methylprednisolone: 4 mg tablets, 7 tablets per day, divided into 2 doses (4 tablets in the morning and 3 tablets at lunchtime). The effectiveness of the therapy was evaluated based on the primary combined endpoint of the study, which included progression of the disease to an extremely severe form or the occurrence of pulmonary and extrapulmonary complications that required transfer to the intensive care unit, or death of the patient during the followup period. The secondary combined endpoint of the study was resolution of clinical symptoms of the disease or achievement of reference values of laboratory and instrumental indicators. Results. No lethal outcomes were observed in the compared groups, there were no cases of development of an extremely severe course, complications requiring transfer to the intensive care unit in the main group. Conclusion. Early use of small doses methylprednisolone of in comprehensive therapy of patients with moderate and severe COVID-19 pneumonia reduces the incidence of life-threatening complications and improves the outcomes of the disease. © Salukhov V.V., Kryukov E.V., Chugunov A.A., Kharitonov M.A., Rudakov Y.V., Lakhin R.E., Dancev V.V., Stepanenko I.A., Gurba M.O., Stepanova T.V., Bolekhan A.V., Arzhavkina L.H. 2021.

Topical issues of diagnostics, examination and treatment of patients with covid-19-associated pneumonia in different countries and continents

The lack of effective etiotropic methods of treatment and prevention of the new coronavirus infection (COVID-19), which caused the pandemic in 2020, determines the relevance of the review of researches of medicines for etiotropic and pathogenetic therapy. Most patients are diagnosed with pneumonia, the disease is especially difficult in people with concomitant chronic diseases, since COVID-19 leads to their decompensation, which can lead to death. To assess risk factors for mortality, scientists are developing programs to transfer the patient to appropriate treatment in a timely manner. This article analyzes the clinical efficacy of various agents for etiotropic and pathogenetic treatment of a new coronavirus infection based on data from international researches. Etiotropic medicines used at the beginning of the pandemic did not show their effectiveness in reducing the duration of treatment, the development of death, and preventing the transition to the use of mechanical ventilation. There are described researches of vaccines against a new coronavirus infection, developed in the Russian Federation, the USA, Germany and the UK, which showed the greatest efficiency (more than 90%) in preventing COVID-19. The World Health Organization initiated the international clinical research SOLIDARITY, according to which all medicines participating in the trials have little or no effect on overall mortality, the onset of ventilation requirements and the length of hospital stay in hospitalized patients. Now, only systemic glucocorticosteroids have proven effective against severe and critical forms of COVID-19. Thus, effective etiotropic drugs for the treatment of COVID-19 have not been developing, however, an active search for these funds and the development of vaccines to prevent the incidence of coronavirus infection are underway. © 2020, Remedium Group Ltd. All rights reserved.