Ультразвуковое исследование легких: актуальный метод в условиях новой коронавирусной инфекции SARS-CoV-2

A literature review of the main issues of ultrasound diagnosis during the period of the SARS-CoV-2 coronavirus infection pandemic. The review shows the key aspects of ultrasound, the experience of foreign colleagues, reflecting the basic principles of ultrasound diagnostics when working with infected patients, the methodology of the distribution of people into the streams with their increased admission to hospitals in a pandemic.Представлен обзор литературы по основным аспектам проведения ультразвукового исследования легких у больных в период пандемии коронавирусной инфекции SARS-CoV-2, основанным на опыте ведущих научных центров разных стран. Продемонстрирована перспективность применения данного метода у больных с патологией легких, особенно в условиях подобной пандемии

Post-COVID immunopatology syndrome: characteristics of phenotypical changes in the immune system in post-COVID patients

This study examines the long-term effects of SARS-CoV-2 infection on immune status. Given the prolonged and profound immune dysregulation observed during acute SARS-CoV-2 infection, it remains to be determined whether these changes translate into subsequent immune system dysfunction in recovering individuals. In this sense, the aim of the study was to study the parameters of the immune system in patients who had undergone SARS-CoV-2 infection. 150 patients who underwent SARS-CoV-2 infection were examined according to 96 parameters using flow cytometry. A complete blood count was performed using a Medonic device (Sweden); ELISA method determined the levels of general and specific IgM, IgG, IgA, compliment fragments (JSC Vector-Best, Russia). The activity of the phagocytes was studied according to the generally accepted method. The study found that at least four phenotypes of immune system disorders are detected in patients. The first two phenotypes are related to the impairment of innate immune system factors and are associated with a decrease in the number of CD46+ and NK cells. It has been observed that a decrease in CD46+ persists for a long time in a significant number of recovered patients, highlighted by the impaired expression of this marker in various subpopulations of lymphocytes. The decrease in the level of natural killers was accompanied by a compensatory increase in the number of T lymphocytes, mainly due to T helpers and TNK lymphocytes, and the growth of total memory B cells. Two other identified phenotypes are characterized by damage to acquired immune response factors and are associated with damage to B cells and T cytotoxic cells. The relationship of such disorders with damage to hematopoiesis erythrocyte and platelet sprouts, which contribute to the appearance of hypoxia and possible violation of the blood coagulation system, has been shown. Therefore, the results obtained indicate a long-term pronounced damage to the immune system in postCOVID patients that requires immunocorrection of these disorders

PERFORMANCE OF THE VASCULAR STIFFNESS INDICATORS AND THE PROCESS OF LEFT VENTRICLE REMODELING IN HYPERTENSIVE PATIENTS UNDER RENAL REPLACEMENT THERAPY

Objective. The objective of our study was to compare the performance of vascular stiffness (VS) and the left ventricular (LV) remodeling process indicators in patients with arterial hypertension (AH) under renal replacement therapy (RRT), and patients with essential hypertension.Design and methods. 158 people were included in the study, divided into 4 comparable age groups: 32 patients receiving programmed hemodialysis (PH), 37 recipients of renal transplant (RT), 69 patients with essential AH and 20 healthy volunteers. All the patients underwent 24-hour blood pressure (BP) monitoring with an assessment of VS and central BP (SBPao) and echocardiography (EchoCG).Results. The patients under PH and after RT did not have any significant differences in the values of central and peripheral BP. Comparing the groups of patients under RRT with the group of essential AH, the office systolic (SBP) and diastolic (DBP) BP values did not differ significantly. Аlthough, at night, considerably higher DBP(n) and SBPao(n) values were detected in patients under RRT, and in the patients after RT SBP(n) and PP(n) values were also increased. An increase in the SBPao values of more than 10 m/sec was detected only in the groups of patients under RRT. In all the groups with hypertension all indicators of daily VS differed significantly from the group of healthy volunteers. PTIN (Pulse Time Index of Norm) in the studied groups had more evident differences: in the healthy volunteers it was in the range of 80-90%, in the patients with essential hypertension — 50-60%, and in the patients under PH and after RT — 20-40%. In all groups of patients with AH, the average the posterior wall thickness (PWT) of the LV and the interventricular septum thickness (IVST) were close to the upper limit of the norm. In the groups of patients with AH an increase in the relative wall thickness (RWT) of the LV was also detected. Furthermore, considerably higher the values of ILVmass, IVST were found in the group of patients on PH in comparison with the patients after RT. In addition, in all the groups of patients with AH, there was a tendency to LV spherification in comparison with the healthy volunteers, and in the group of essential AH the difference was more pronounced compared with the group under RRT.Conclusion. In the patients with arterial hypertension who undergo renal replacement therapy, higher average values of central BP, higher vascular stiffness (daily pulse wave velocity in the aorta and a longer period of pulse wave velocity increase in the aorta during the day (PTIN)) and less pronounced left ventricular spherification are recorded in comparison with the patients with essential hypertension while office BP values remained consistent

Vessel wall stiffness parameters and left ventricle remodeling in patients receiving renal replacement therapy

Aim. To perform a comparative assessment of vessel wall stiffness parameters and left ventricle (LV) remodeling in groups of patients with arterial hypertension (AH) receiving renal replacement therapy (RRT) and patients with hypertensive heart disease.Material and methods. One hundred fifty eight people were examined: 32 patients on program hemodialysis (PG), 37 — after kidney transplantation (KT), 69 — with essential hypertension and 20 healthy volunteers. All patients underwent 24-hour blood pressure (BP) monitoring with an assessment of the parameters of daily vessel wall stiffness, aortic pressure and Mand B-mode echocardiography.Results. In groups of patients with PG and after KT, the central and peripheral blood pressure did not differ significantly. When comparing with the group of essential hypertension in RRT patients, with similar values of office systolic and diastolic BP, higher average values of peripheral and central BP were determined. An increase in the values of the pulse wave velocity in the aorta of more than 10 m/s was observed only in RRT patient groups. In all groups of patients with AH, BP and vessel wallConclusion. Patients receiving RRT have higher values of the average daily pulse wave velocity in the aorta, central BP and a longer period of an increase in the pulse wave velocity in the aorta during the day, higher vessel wall stiffness values, and less pronounced LV spherification than in patients with hypertensive heart disease and comparable values of office BP

Drug Safety Issues in Therapy COVID-19

One of the serious problems of modern Health care is a new coronavirus infection — COVID-19, which has been declared a global pandemic by the World Health Organization and has covered more than 190 countries. Despite the measures has been taken to limit contacts between people and isolate patients with suspected coronavirus infection, the number of cases grows exponentially every day. Leading laboratories are working on a vaccine, but according to some optimistic forecasts, it may be available no earlier than 11-12 months. According to published data on attempts using various drug regimens in clinical trials, methodological manuals and clinical guidelines for patient management are constantly being developed and updated depending on the severity of the condition. The appointment of a number of drug combinations should be carried out taking into account the definition of an individual assessment of the benefits and risks, because there is ample evidence of serious side effects.More serious lung tissue lesions are characteristic of patients of an older age group (over 60 years old) with the presence of concomitant diseases, such as cardiovascular, cerebrovascular, diabetes mellitus and obesity, diseases of the bronchopulmonary system and kidneys, which implies taking basic therapy in a constant mode. The appointment of a number of drug combinations should be carried out taking into account the definition of an individual assessment of the benefits and risks, because there is enough evidence of serious side effects, such as the QT interval prolongation, hepatotoxicity, adverse events from the central nervous system. It is necessary to evaluate the interaction of drugs used to treat infections caused by the COVID-19 virus with drugs used in outpatient practice