Vol 75, No 5S (2020)

Background. The paper discusses the use of a thermal helium-oxygen mixture (t-Не/О₂ ), a novel technology, in treating patients with the 2019-nCoV acute respiratory disease (COVID-19) who develop life-threatening respiratory failure.

Aim – to evaluate the safety and efficacy of t-Не/О₂ inhalation combined with standard therapy in the treatment of acute respiratory failure in patients with COVID-19.

Materials and Methods. This was a single-center, randomized, prospective study of 70 patients with COVID-19. All patients were divided into two groups: in Group 1 (n = 38) patients received t-He/О₂ in addition to the standard COVID-19 treatment; and in Group 2 (n = 32) patients were given the standard treatment in accordance with the Clinical Treatment Guidelines for patients with COVID-19, developed by the Ministry of Health of the Russian Federation. The male/female ratio was 18/20 in Group 1 and 18/14 in Group 2. The mean age of the patients in the study was 53.5 years (43; 62): 56 years (42; 64) in Group 1 and 52 years (43; 66) in Group 2. All patients had computed tomography (CT) signs of lung injury: ground-glass opacities and areas of consolidation. SARS-CoV-2 RNA was detected in 30 Group 1 patients and 28 Group 2 patients. The patients were matched by sex, age, body mass index (BMI), area of pulmonary involvement, and laboratory findings. All patients provided voluntary informed consent to participate in the study and signed a consent form.

Results. Inhalation of thermal helium-oxygen mixture combined with standard therapy did not cause any procedure-related side effects in any of the patients. The following changes were observed in all patients: pO₂ /FiO₂ , SpO₂ , and lymphocyte counts increased, C-reactive protein (CRP) levels decreased, and D-dimer and ferritin levels returned to normal. In Group 1 statistically significant changes in the above-mentioned parameters were seen within three days, while in Group 2 the same changes were observed between Days 7 and 10 of treatment. In Group 1 patients cleared SARS-CoV-2 within 48–72 hours after initiation of inhalation, which was confirmed by polymerase chain reaction (PCR), and in Group 2 virus elimination was achieved within 72–168 hours.

Conclusion. The addition of inhalation of a thermal gas mixture of helium and oxygen (t-He/О₂ ) to the standard therapy for patients with SARS-CoV-2 infection, CT signs of pneumonia (grades СT2 or CT3), and acute respiratory failure improves gas exchange, contributes to a more rapid virus elimination, and indirectly reduces inflammation.

The new coronavirus infection pandemic has certainly changed all spheres of human activity, the healthcare system was completely transformed and reassignment in a short time. The built model of a personalized approach to each patient was replaced by the provision of health services to groups of patients with similar symptoms of the disease and severity, and conditions not associated with coronavirus infection, anyway, took a back seat. Since the announcement of the COVID-19 pandemic, the main human and material resources have been directed at combating the new infection. To date, almost every country has cases of coronavirus infection. The planned surgical care was temporarily stopped, what could not but affect the outcomes of diseases. A special category of patients is represented by patients with diagnosed malignant neoplasms, the delay in treatment of which can significantly reduce the life expectancy and/or quality of life. The current state of the problem served as a catalyst for the development of telemedicine technologies, which simplified communication in the patient-physician and physician-physician relationship. Urinary tract infections are one of the most common reasons for visiting a urologist, which implies the prescription of antibacterial drugs. However, in a pandemic, remote prescription of these drugs is limited by the lack of face-to-face specialist consultations. This enabled make it possible to use drugs based on bacteriophages. Patient management problems were solved by using distance counseling techniques. In this article we present an algorithm for providing urological and oncourological care to patients in the context of the COVID-19 pandemic, as well as an overview of the existing world practice in the implementation of telemedicine consultations in the current epidemiological situation.

Introduction. On December 31, 2019, the World Health Organization announced the coronavirus (COVID-19) outbreak and medical workers appeared on the frontline in combating the new threat. Daily interactions with infected patients, extended working hours and psychological overload: all this makes healthcare professionals extremely vulnerable to a new danger. Therefore, the actual priority is to prevent the nosocomial spread of the disease and the protection of medical personnel.

Aim — exploration and generalization of Russian and international experience of COVID-19 pandemic combating in terms of creating the most efficient system of health workers’ protection against the infection, caused by a new virus SARS-CoV-2.

Methods and materials. The systematic reviews and meta-analyzes reporting method (PRISMA) were used in the review. The search was carried out in the bibliographic databases Elibrary, PubMed, MEDLINE, Scopus, Google Scholar. Moreover, Russian and foreign methodological documents from the official websites of organizations were analyzed.

Results. Examination of epidemiologically safe space organizing models in different countries showed that the majority of the existing in the world community approaches to protect medical personnel from contracting a new coronavirus infection are based on five basic strategies of infection prevention and control to prevent or limit the transmission of COVID-19 proposed by the World Health Organization. The article proposes a sixth strategy in addition to the above: psychological support for health workers.

Conclusion. Effective use of the listed complex of six protective measures can minimize the risk of medical workers’ infection with coronavirus.

Background. COVID-19 is an infectious respiratory syndrome with a wide range of manifestations and outcomes. Patients with inflammatory bowel disease (IBD) generally have a higher risk of infection, especially if they receive immunosuppressive therapy.

Aim — to describe the manifestations of COVID-19 in patients with IBD and to determine the risk factors for severe COVID-19.

Methods. The analysis included 68 patients with an established diagnosis of Crohn’s disease (CD) or ulcerative colitis and a confirmed new coronavirus infection. The diagnosis of coronavirus infection was established when SARS-CoV-2 was detected by PCR using nasopharyngeal smears, and computer tomography (CT) of the chest revealed inflammatory changes characteristic of coronavirus lung damage or high IgG and IgM titers based on the results of immunological blood analysis.

Results. 68 patients with IBD and COVID-19 were observed in the Department of IBD, including 27 (39.7%) patients with CD, 41 (60.3%) patients with UC. Among patients diagnosed with pneumonia, 100 % of patients received therapy with thiopurines and infliximab. 8 (11.8%) patients were diagnosed with COVID-19 during hospitalization for a severe IBD attack. There was no statistically significant difference between UC and CD patients in terms of disease activity (p = 0.13) during the period of coronavirus infection. In 37 patients (26 — UC, 11 — BC) with pneumonia (100%), there was an exacerbation of IBD. Statistical significance was found between the development of more severe lung damage (CT 3–4) and IBD activity at the time of diagnosis of COVID-19 (p < 0.001), the presence of comorbidities (p < 0.001) and taking GCS (p < 0.001) at the time of detection of COVID-19. However, the use of biological and immunosuppressive therapy was not associated with a higher risk of severe lung damage and the need for a ventilator. It was shown that the age of patients over 65 years was statistically correlated with the need for a ventilator (p = 0.02).

Conclusion. The exacerbation of the disease, especially in elderly patients with comorbidities, the use of glucocorticosteroids was associated with negative consequences of COVID-19, while biological and immunosuppressant drugs used for the treatment of IBD did not have such a negative effect.

Background. The COVID-19 pandemic has a significant impact on the mental state of not only quarantined citizens and patients, but also health workers.

Aims — asessment of the mental health of doctors involved in work in the “red zone” during the COVID-19 pandemic.

Materials and methods. 77 respondents were interviewed using the HADS questionnaires and the Maslach burnout test. For statistical data processing Microsoft Office Excel 2016, IBM SPSS were used.

Results. An increase on the depression scales was noted in 7%, anxiety in 23%, and anxiety and depression together 27%. According to the Maslach questionnaire, 32 doctors (41.5%) noted a reaction of the type of “emotional devastation”. 10 doctors (12.9%) noted a reaction “reduction of professional achievements”. Three doctors (3.8%) had a dehumanization reaction in the form of dull emotions to colleagues and patients.

Conclusions. Work in the “red zone” has a significant negative impact on the mental health of doctors and medical personnel.

Background. The pandemic of the new coronavirus infection has challenged the medical community for quickly finding and implementing effective methods of treatment. In the absence of a vaccine or specific therapy with proven effectiveness, the usage of convalescent plasma can be the one of perspective methods. An important aspect of this technology is the efficient and safe preparation of convalescent plasma. To date, in the world literature there are practically no publications about donor recruitment and the specifics of the preparation of convalescent plasma.

Purpose of the research. Presentation of the experience of organizing a workflow for recruiting donors and stockpiling of convalescent plasma with a high titer of virus-neutralizing antibodies to SARS-CoV-2.

Methods. The analysis of the work of the Blood Service of the Moscow Department of Health for stockpiling of COVID-19 convalescent plasma has been executed. In total it has been stockpiled 1240 doses. The normative documentation has been developed by a working group on the basis of the current federal legislation of Russian federation and been approved by the Moscow Department of Health. The titer of neutralizing antibodies (VNA) has been determined as the basic method for assessing the immunological viability of convalescent plasma. The main characteristics of donors, the characteristics of the disease course, the results of preliminary testing for the presence of specific antibodies by ELISA and CLIA methods has been compared with VNA titers in the stockpiled convalescent plasma.

Results. Due to a Moscow Health Department’s order No. 325 dated 01.04.2020 (a basic local regulatory document) it has been developed a regulation for the stockpiling, examination, storage, safety and transfering of fresh frozen pathogen-reduced plasma of COVID-19 convalescent donors to medical organizations of the Moscow Health Department. For arranging an interaction with donors it has been created a call-center. For effective preliminary selection, it has been formed a donor characteristics list, which has been combined with screening of specific antibodies by ELISA and CLIA methods.

Conclusions. Developed a system of recruiting donors and procurement process of convalescent plasma for treatment СOVID-19, which includes the necessary regulations, algorithms for the selection and recruitment of donors, the registry of donors and recipients, algorithms, efficiency and safety of convalescent plasma.

Background. The pandemic of coronavirus pneumonia (COVID-19) is spreading globally at an accelerated rate and is a major health problem. The purpose of this study was to assess the possibility of using a combination of radiation diagnostic methods in lung lesions in pregnant women, with confirmed coronavirus infection and suspected COVID-19 pneumonia, hospitalized in O.M. Filatov Municipal Clinical Hospital No. 15, Moscow.

Methods. Retrospectively analyzed changes in lung parenchyma and pleura detected by multispiral computed tomography of chest organs and pulmonary ultrasound in 90 pregnant patients with clinical manifestations of viral pneumonia and confirmed coronavirus infection.

Results. Examined 90 patients with clinical manifestations of pneumonia and PCR-confirmed COVID-19. Among the clinical manifestations, coughing, fever, shortness of breath prevailed. Most changes detected by lung tomography (performed in 92% of patients), had a polysegmental and bilateral character, were more often localized in the peripheral departments, in 74 (89%) patients were involved in a pathological process of more than two lobes, in 77 (93%) of the patients were determined the centers of pulmonary tissue compaction by the type of “ground glass”, and the combination of the above manifestations with the presence of foci of consolidation and reticular changes was noted in 23 (28%) cases. Among the complications more common: thickening of the pleura, hydrothorax, less often pneumothorax. In 43 (48%) patients, MSCT was supplemented by ultrasound examination of the lungs and pleura, and in 21 (23%) patients, ultrasound was used in isolation as a dynamic control tool to reduce dose load and comply with the ALARA principle, while in 7 (8%) patients, ultrasound was used as the only diagnostic tool due to refusal to perform MSCT.

Conclusion. Radiosemiotics of lung lesions in pregnant women with COVID-19, detected in MSCT of thoracic organs, does not differ from that in non-pregnant patients. The appearance of specific zones of pulmonary tissue compaction in the form of a “gound glass”, as a manifestation of a unilateral or bilateral, mono- or polyphocal lung lesion, is highly likely to indicate a manifestation of COVID-19. Pulmonary ultrasound also allows detecting characteristic changes in lung parenchyma and pleura in pregnant women, correlating with MSCT data, primarily in patients with medium-severe forms of pneumonia. Use of ultrasonography corresponds to the principle of ALARA in medicine, remaining a choice method with the women refusing the visualization interfaced to beam loading that can be used in the period of COVID-19 pandemic.