Pseudomembranous colitis as a complication in Covid-19.

OBJECTIVE: Aim: To improve the results of treatment of patients with pseudomembranous colitis against the background of coronavirus infection. PATIENTS AND METHODS: Materials and Methods: The study presents the results of a retrospective analysis of 96 patients with pseudomembranous colitis, who were treated in the infectious Covid department at the base of the Uzhhorod City Clinical Hospital since 2020 to 2022. The average age of patients was 55.2 years, there were 38 (39.5%) men and 58 (60.5%) women. Diagnosis of complications - pseudomembranous colitis (PMC) - was based on clinical data, ultrasound and CT of the abdominal organs, fibrocolonoscopy, laparoscopy. RESULTS: Results: The frequency of PMC from the total number of patients who were in hospital treatment (8205 patients) due to COVID-19 was 1.17%, and this indicator was 0.62% in 2020, and 2.28% in 2021. Indications for operative treatment were: colon perforation - 9.4% of patients; peritonitis (diffuse, widespread) without obvious perforation of the colon wall - 85.5% of patients; mesenteric thrombosis - 4.1% of patients. In the case of perforation of the colon, resection of the colon was performed with the formation of a proximal colostomy and ileostomy. In case of mesenteric thrombosis, resection of the affected part of the small intestine was performed. In case of peritonitis without clear intraoperative detection of perforation of the colon wall, intraoperative lavage was performed. CONCLUSION: Conclusions: 1) The frequency of detection of PMC in patients with COVID-19 in 2020 was 0.62%, and in 2021 - 2.28%. 2) The sensitivity of CT in the diagnosis of surgical complications of PMC was 72%, and the specificity was 58%. 3) Conservative treatment was effective in patients with PMC in 88.8% of cases, 21.2% had complications that required emergency surgical interventions. 4) The total mortality in patients with PMC was 11.36%, although this indicator was significantly higher in the event of surgical complications and operative treatment (22.4%).

EFFECT OF PROLONGED TREATMENT WITH BIOLOGICAL THERAPY IN PATIENTS WITH ULCERATIVE COLITIS WITH CONCOMITENT JOINT DAMAGE.

OBJECTIVE: The aim: Is to compare the effects of tofacitinib, adalimumab and budesonide clinical and laboratory signs of patients with moderate UC with concomitant articular syndrome. PATIENTS AND METHODS: Materials and methods: 100 patients with moderately severe UC. Patients were divided into 2 groups. The I group consisted of patients with UC, which were treated with tofacitinib 10mg bid (TOF; n=28). II group consisted of patients who were treated with adalimumab with a starting dose of 160 mg and 80 mg on the 2nd week of treatment, after which they received a subsequent dosage of 40 mg per week (ADA; n=32). Patients in the III group received budesonide 9mg qd (BUD; n=40). RESULTS: Results: As a result of treatment in the TOF research group, leukocyte and CRP levels decreased compared to readings before treatment (from 13.6±2.4*109/l and 1698 14.0±1.4mg/l to 10.6±1.2*109/l and 11.0±2.1 mg/l respectively, p<0.05). Hemoglobin levels in this group slightly increased (from 104.2±9.2 g/l to 126.1±10.2 g/l, p<0.05). Among ADA patients, there was also an improvement in laboratory signs: leukocyte and CRP levels decreased (from 13.8±2.8*109/l and 16.0±1.2 mg/l to 6.0±2.2*109 /l and 11.8±1.2 mg/l respectively, r<0.05), hemoglobin increased (from 103.8±8.2 g/l to 118.6±8.6 g/l/l r<0.05). CONCLUSION: Conclusions: Tofacitinib and adalimumab in the treatment of patients with ulcerative colitis of moderate severity with concomitant joint damage showed a higher clinical and laboratory effectiveness compared to treatment with budesonide.