COVID-19: OBSERVATIONS ON STANDARD TREATMENT ALGORITHMS

In this article, a retrospective analysis of the medical histories was carried out in order to develop an individualized approach to treating COVID-19. Questions were raised about the advisability of the universal immunosuppressive therapy, the need to prescribe glucocorticosteroids only taking into account the cytokine profile of patients, the relationship of glucocorticosteroid therapy and carbohydrate metabolism disorders, as one of the most common complications of pharmacotherapy COVID-19 in the patients we studied. Unjustified immunosuppression in the stage of active fight against the infectious agent as a factor of chronization of the process and decrease of the body reactivity, as well as neutralization by immunosuppressive therapy of factors of protection of innate non-specific immunity mobilized to fight the causative agent. The importance of taking into account the probability of thrombosis with consideration of coagulogram indices and thrombosis markers (D-dimer, fibrin degradation products) does not exclude the risk of the hemorrhagic complications when prescribing high doses of anticoagulants. Antibacterial therapy for uncomplicated viral infections is neither an etiologic nor a pathogenetic treatment option. In addition, it leads to the emergence of resistant strains of microorganisms as a result of mutational variability and evolutionary adaptations of bacteria, which greatly complicates the choice of an effective antibacterial drug in some cases. Antithrombotic, glucocorticosteroid and antibacterial therapy should be clinically and laboratory justified in each individual case. The article focuses on the safety of prescribing antipodagric agents in the treatment of COVID-19 as anti-inflammatory. The review considers all the above-mentioned aspects of COVID-19 therapy with reference to foreign studies, describes options for the pathophysiological development of infection. We note the need to develop systematic data on coronavirus, changes that the pathogen induces in the body. This will allow the development of innovative and effective therapeutic strategies for the treatment of the new coronavirus infection

Ступенчатая схема лечения бронхиальной астмы у детей: step up или step down?

This trial was aimed to a comparative evaluation of clinical efficiency of different approaches (step up and step down) to moderate bronchial asthma management in children.This study was designed as a single-blinded randomized parallel-groups trial. It involved 50 children with moderate asthma aged from 6 to 15 years; they were divided into 2 groups. The 1st group patients received fluticazone propionate 200 meg daily for 12 weeks. Then they were transferred to the treatment with sodium cromoglicate in a dose of 20 mg daily (step down). The children included into the 2nd group received sodium cromoglicate as a starting therapy. The evaluation of the treatment efficacy was assessed in 4 weeks. When the initial treating course was declared to be successful the patients went on to receive the same drug for 20 weeks more (the 2A group). In a case of unsatisfactory effectiveness of the therapy with sodium cromoglicate the children were administrated fluticazone propionate for 12 weeks (step up) and then they were transferred to the cromoglicate therapy (the 2B group).The trial protocol included an assessment of main asthmatic signs intensity, respiratory function parameters, severity of bronchoconstruction after exercise, a degree of metacholine-induced bronchial hyperresponsiveness and quality of the children’s life.It was demonstrated that the step down approach is more preferable in moderate asthma children during basic anti-inflammatory therapy as far it facilitates to achieve the stable asthma condition in short time, to prevent successfully a bronchoconstruction after exercise and to reduce most significantly the bronchial hyperresponsiveness. All these conditions considerably improve the quality of the patients’ life. The replacement of fluticazone propionate to sodium cromoglicate in the children leads neither to worsening of asthma course nor to decreasing of expiratory flow value and does not cause a great reinforcement of bronchial hyperresponsiveness in overwhelming majority of patients as well.Целью работы явилось проведение сравнительной оценки клинической эффективности различных подходов (step up и step down) к лечению среднетяжелой бронхиальной астмы у детей.В работу (дизайн — простое слепое рандомизированное исследование в параллельных группах) было включено 50 детей со среднетяжелым течением астмы в возрасте от 6 до 15 лет, которые были разделены на 2 группы. Пациентам 1-й группы в качестве стартовой терапии был назначен флутиказона пропионат в дозе 200 мкг/сутки в течение 12 недель, затем больные переводились на терапию кромогликатом натрия в дозе 20 мг/сут (подход step down). Дети, вошедшие во 2-ю группу, в качестве стартовой терапии получали кромогликат натрия. Через 4 недели проводилась оценка эффективности лечения. В случае если начальный курс терапии был признан успешным, больные продолжали получать этот препарат еще в течение 20 недель (группа 2А). В случае недостаточной эффективности лечения кромогликатом натрия детям назначался флутиказона пропионат в течение 12 недель (подход step up), а затем дети вновь переводились на терапию кромогликатом натрия (группа 2В).Протокол исследования включал оценку выраженности основных клинических симптомов бронхиальной астмы, показателей функции внешнего дыхания, тяжести постнагрузочного бронхоспазма, уровня метахолининдуцированной бронхиальной гиперреактивности и качества жизни детей.Показано, что использование подхода step down при проведении базисной противовоспалительной терапии у детей со среднетяжелым течением бронхиальной астмы является наиболее предпочтительным, поскольку обеспечивает достижение более стойкой ремиссии заболевания в короткие сроки, эффективное устранение постнагрузочного бронхоспазма и наиболее значимое снижение уровня бронхиальной гиперреактивности. Все это обуславливает существенное улучшение качества жизни больных. Перевод детей с флутиказона пропионата на кромогликат натрия не приводит к утяжелению течения заболевания, снижению скоростных показателей выдоха и существенному возрастанию уровня бронхиальной гиперреактивности у подавляющего числа больных

Preservation of the immunomodulatory effect of interval hypoxytherapy after coronavirus infection in the long-term period

The new coronavirus infection COVID-19, due to the complex pathogenesis of the disease, systemic impact on organs, the development of complications and persistent disorders after the infection, remains an important medical problem. Every year the number of patients with postcovid syndrome in need of timely and full rehabilitation is increasing. Recently, isolated work began to appear on the use of interval hypoxytherapy for the treatment of patients with coronavirus infection. The purpose of our study was to identify the long-term results of the effect of interval hypoxytherapy on the immunological and coagulation status of patients after suffering coronavirus infection COVID-19. 170 patients aged 45 to 59 years were examined after a moderate coronavirus infection before, after and three months after interval hypoxytherapy. The number of lymphocytes, immunoglobulins A, M, G, E and cytokines (IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, TNFα) in blood, blood D-dimer, prothrombin time, fibrinogen in blood, antithrombin III, C-reactive was determined protein and ferritin in the blood. The conducted studies revealed changes in immunological reactivity after the coronavirus infection COVID-19, requiring correction. Interval hypoxytherapy had an immunomodulatory effect and led to the normalization of the main immunological parameters, which remained three months after hypoxytherapy: there was a significant (p < 0.05) increase in the number of CD3+T lymphocytes, CD4+T lymphocytes, CD8+T lymphocytes. The improvement in immune status was also evidenced by the normalization of the immunoregulatory index, an increase in the level of immunoglobulins A and G. The decrease in immunoglobulins E in the blood was an indicator of a decrease in the severity of sensitization of the body. The course of hypoxytherapy led to a decrease in the content of pro-inflammatory cytokines: IL-1β, IL-2, IL-6, IL-8, TNFα and an increase in anti-inflammatory cytokines: IL-4 and IL-10 in the blood, which indicated an attenuation of the inflammatory process in the lung tissue and in the body as a whole. Blood ferritin decreased 3 months after hypoxytherapy. As studies have shown, the effect of hypoxytherapy persists for three months after the course of treatment. Thus, interval hypoxytherapy can be recommended for the rehabilitation of patients after a moderate coronavirus infection. A repeated course of hypoxytherapy may be performed three months after the first course of hypoxytherapy

Сравнение эффективности сопоставимых доз ингакорта, беклометаизихейлера и фликсотида-дискуса при последовательном их назначении больным бронхиальной астмой

Twenty patients (12 females and 8 males) suffering from stable moderate non-atopic bronchial asthma and receiving Ingakort in the supporting dose 1000 to 1500 meg daily (in average 1150 meg daily) during 6 to 8 months, were moved up to 4-week treatment with 600 to 800 meg daily of dry powders of Beclomethazoneeasyhaler (660 meg daily in average) and 500 meg daily of Flixotide-diskus sequentially. Dynamics of clinical symptoms in marks, need for beta-2-agonists, pulmonary function parameters, airways obstruction reversibility tested by response to Salbutamol and local adverse events were investigated.The reliable regression of asthma clinical symptoms was revealed in 2 weeks of treatment with dry powders of Beclomethazone and Flixotide and that of need for beta-2-agonists was obtained in 4 weeks. This effect was greater against the treatment with Flixotide-diskus background. The large bronchi’s passability was improved but FEV1, FEF50 and FEF25 changes were not significant. No local adverse events were revealed.The results obtained confirm the comparability of the doses mentioned above of Ingakort, Beclomethazone and Flixotide, high efficacy and safety of their powdered forms as well.20 больных (12 женщин и 8 мужчин) с неатопической формой бронхиальной астмы средней тяжести течения вне обострения, получавших в течение 6—8 месяцев поддерживающие дозы ингакорта в среднем 1150 мкг/сут (1000— 1500 мкг/сут), были переведены на 4-недельный последовательный прием сухих порошков 600—800 мкг/сут беклометазона-изихейлера (в среднем 660 мкг/сут) и 500 мкг/сут фликсотида-дискуса. Изучалась динамика клинических симптомов в баллах, потребность в (β2-агонистах, показатели ФВД, обратимость бронхиальной обструкции в тесте с сальбутамолом, местные побочные явления.Через 2 недели лечения сухими порошками беклометазона и фликсотида выявлен достоверный регресс выраженности клинических симптомов астмы и через 4 недели — суточной потребности в β2-агонистах, причем более значимый на фоне лечения фликсотидом-дискусом. Улучшалась бронхиальная проходимость на уровне крупных бронхов, а динамика ОФВ1, МОС50 и МОС25 была недостоверной. Местные побочные явления не выявлены. Полученные результаты подтверждают сопоставимость и безопасность последних в виде сухих порошков