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Vol 26, No 1 (2021)

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REVIEW ARTICLES

Epidemiology of COVID-19

Shakhmardanov M.Z., Nikiforov V.V., Skryabina A.A., Tomilin Y.N., Abusueva A.S., Burova S.V.

Abstract

The review examines and discusses the spread of COVID-19, current sources of the pathogen, mechanisms and ways of transmission of SARS-CoV-2. It is shown that the leading sources of infection in the ongoing COVID-19 pandemic are patients with manifest forms of the disease on the 1st-2nd day of the disease. A week after the appearance of the first symptoms of the disease, the epidemiological significance of patients as sources of infection decreases sharply. And unlike many other respiratory infections, patients with subclinical forms of the disease who remain highly active are less dangerous epidemiologically.

Despite the fact that the causative agents of severe acute respiratory syndrome have penetrated into the human population from small vertebrates, the epidemiological significance of the latter in the ongoing COVID-19 pandemic is negligible. The actual mechanism of transmission of SARS-CoV-2 is aspiration. The other mechanisms of pathogen transmission (fecal-oral, transmissible, contact, vertical), previously discussed as competing with aspiration, have no epidemiological significance. The main transmission path of SARS-CoV-2 is airborne. The contact-household transmission path is much less relevant, and other ways are not proven. Leading in the spread of the virus in the human population is a relatively close (up to 2 meters), long-term, not protected by personal protective equipment, contact of the patient with a healthy one. There is no epidemiological significance of long-distance transmission of the virus.

Epidemiology and Infectious Diseases. 2021;26(1):5-14
pages 5-14 views

ORIGINAL STUDIES

Clinical efficacy of assisted intranasal ventilation after polysegmental pneumonia caused by the SARS-CoV-2 virus

Nikiforov V.V., Stebletcov S.V., Maslennikova O.M., Zakirova A.S., Pashovkina O.V.

Abstract

BACKGROUND: The development of ways of rehabilitation of patients after polysegmental viral pneumonia that enable the collapsed alveoli being transferred to a ventilated and actively perfused state is certainly relevant. In this regard, non-invasive respiratory support can be considered as a reasonable additional method of treatment for these patients.

AIMS: Assess the feasibility of non-invasive assisted ventilation of the lungs after suffering polysegmental pneumonia caused by the SARS-CoV-2 virus.

MATERIALS AND METHODS: The study included 40 patients after bilateral polysegmental pneumonia caused by the SARS-CoV-2 virus. The first group of patients (21 people), in addition to the standard treatment, underwent non-invasive assisted intranasal ventilation in the BiPAP mode with a final expiratory pressure of 4–8 cm of water. Art. 60 minutes three times a day for 10–12 days. The second group (19 people) did not receive ventilation benefits. Before the start of therapy and at the end of the course, spirometry, computed tomography of the chest organs were performed with the calculation of the volume of the affected lung tissue according to the Thoracic VCAR program.

RESULTS: Upon completion of the course of treatment and rehabilitation measures in patients of the first group, the following was observed: a decrease in atelectatic changes and pneumofibrosis, an increase in the volume of ventilated areas of the lungs, the volume of the affected lung tissue according to computed tomography significantly decreased (on average, up to 26±9.8%; p <0.05). There was a significant improvement in the indicators of spirometry in the first group. The increase in the volume of forced exhalation in one second was 25–32%, while vital capacity of the lungs was 27–31%. When evaluating long-term pulse oximetry, the average saturation at night in these patients increased from 91.2±2.1 to 96.4±1.8 (p <0.05). Clinical improvement in patients of the first group led to a decrease in bed-days to an average of 15.4, while in patients of the second group it averaged 23.4 days.

CONCLUSION: The use of assisted intranasal ventilation restores the ventilation-perfusion ratio, which is confirmed by a significant improvement in clinical and instrumental parameters.

Epidemiology and Infectious Diseases. 2021;26(1):15-22
pages 15-22 views

Use of corticosteroid hormones in patients with moderate COVID-19: what goals can be achieved

Efremov D.O., Beloborodov V.B., Meshkov A.V.

Abstract

BACKGROUND: There is strong evidence of the effectiveness of glucocorticoids (dexamethasone) in the treatment of critically ill patients with COVID-19. However, the condition of most of them, at the time of hospitalization, is not assessed as severe or critical, but at the same time, with dynamic observation, it may worsen. It is in this group of patients that data on the effectiveness of glucocorticoids use remain few and contradictory.

AIMS: to study the relationship between the use of a short course of corticosteroid hormones (CSH) in recommended doses and clinical and laboratory parameters of generalized inflammation in patients with a moderate course of new coronavirus infection (COVID-19) in a hospital setting.

MATERIALS AND METHODS: The study included 121 patients with probable (clinically confirmed) and confirmed (laboratory) cases of COVID-19. A retrospective analysis of the data of electronic medical records of all patients admitted sequentially from October 1, 2020 to January 31, 2021 was carried out. The demographic indicators, comorbidities, symptoms, clinical indicators, results of laboratory tests and computed tomography were studied. Statistical analysis was performed using the standard Statistica 10 software for Windows.

RESULTS: The data of electronic medical records of 121 patients were studied. Glucocorticoids were prescribed to 71 patients (58.7%), most often dexamethasone was used 70 out of 71 (98.5%). 73 (60.3%) patients had concomitant chronic diseases. 114 (94.2%) were discharged with recovery. patients, died ― 5 (4.1%), the cause of deaths was multiple organ failure. When evaluating groups of patients, in the period before the appointment of glucocorticoids and a similar period of illness in those who did not receive glucocorticoids significant differences were found in the groups in terms of generalized inflammation (body temperature, C-reactive protein concentration), indicators of respiratory disorders (respiration rate, oxygen saturation), according to indicators of the cellular composition of blood (lymphopenia and thrombocytopenia) in patients treated with glucocorticoids. After completing the course of glucocorticoids, patients showed a statistically significant increase in lymphocytes ― by 76.9%, platelets ― by 67.4%. The level of C-reactive protein significantly decreased by more than 4 times. The obtained data show a decrease in the severity of generalized inflammation, correction of the activation syndrome. acrophages, activation of bone marrow germs and positive clinical and laboratory dynamics of COVID-19.

CONCLUSION: The study demonstrated reliable data on a decrease in the activity of generalized inflammation after the use of a short course of corticosteroid hormones in recommended doses. This led to the stabilization of the state in 53 of 71 (73%) patients and the termination of the escalation of further treatment.

Epidemiology and Infectious Diseases. 2021;26(1):23-36
pages 23-36 views

Colloidal silicon dioxide in complex therapy of chronic opisthorchiasis

Beskhlebova O.V., Karbysheva N.V., Nikonorova M.A., Umbetova K.T., Nemilostiva E. .

Abstract

BACKGROUND: The uniqueness of the natural data of the region of Western Siberia, the peculiarities of the hydrological regime ensure the stable functioning of foci of opisthorchiasis with a morbidity rate exceeding the indicators in Russia by more than 2 times. The long-term, sometimes forced coexistence of the human body and helminths often leads to serious consequences, which affects the general level of health of the population of endemic territories. With opisthorchiasis, allergies develop, functional disorders of organs (liver, kidneys) and systems (immune, cardiovascular, respiratory, endocrine, digestion), as well as disorders of fat, carbohydrate, mineral metabolism and, in general, hormonal background.

The diversity and non-specificity of the clinical manifestations of opisthorchiasis expands the relevance of this problem and requires an increase in the effectiveness of care for such patients, which necessitates the use of enterosorbents.

AIMS: is to analyze the effectiveness of the use of the enterosorbent silicon dioxide colloidal (Polysorb MP) in complex therapy of chronic opisthorchiasis.

MATERIALS AND METHODS: 214 patients with the chronic phase of opisthorchiasis were analyzed (57.5% of women and 42.5% of men aged 18 to 55 years). The diagnosis of opisthorchiasis invasion was confirmed when helminth eggs were found in the feces (in 72.7%), eggs and/or marites of opisthorchiasis in duodenal contents (in 27.3%). All patients received standard therapy, which included three stages: preparatory; specific chemotherapy; rehabilitation. The complex therapy of patients in the observation group at the stage of pathogenetic preparation included the use of colloidal silicon dioxide.

Statistical processing was carried out using methods of variational statistics.

RESULTS: The use of the drug silicon dioxide colloidal as part of the complex therapy of chronic opisthorchiasis contributes to a faster improvement ― the relief of allergic manifestations (when using silicon dioxide colloidal amounted to 2.41 (from 2 to 3) days and a significantly significant decrease in total cholesterol and atherogenicity index was noted.

CONCLUSION: Silicon dioxide colloidal has shown efficacy in the treatment of patients with opisthorchiasis invasion and disorders in lipid metabolism. Patients noted excellent tolerability and absence of side effects.

The method of enterosorption can be recommended for the treatment of opisthorchiasis invasion in patients with lipid metabolism disorders.

Epidemiology and Infectious Diseases. 2021;26(1):37-43
pages 37-43 views

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