Vol 7, No 4 (2021)

The aim of the study is to study the prevalence of COVID-19 among HIV-infected patients in Moscow region and the influence of COVID-19 epidemy at the provision of specialized medical care to patients living with HIV. Materials and methods. For the period of 2020-21 were analyzed the data of 158 patients aged 20-71 who were observed at the Moscow city center for the prevention and control of AIDS of the infectious clinical hospital No. 2 (ICH No. 2 of Moscow Healthcare Department) and who had a combined pathology of COVID-19/HIV infection. In addition to standard examination methods, all participants underwent nasopharyngeal swabs for testing for coronavirus (polymerase chain reaction), indicators of immune status (CD4 + lymphocytes, CD8 + lymphocytes), HIV viral load were determined. If COVID-19 was suspected, a chest computed tomography (CT scan) was performed. Results and conclusion. The mutual influence of SARS-CoV-2 infection and HIV was examined in terms of age, sex, stage of HIV infection, immune status, HIV viremia, conditions of specialized medical care performance, use of antiretroviral therapy (ART), the severity of COVID-19 clinical course and the prognosis of the disease. Indicators of immune status, HIV viremia, ART intake, stage of HIV infection, as well as the location of receiving specialized medical care (inpatient / outpatient treatment) had a correlation with the severity of COVID-19/HIV coinfection and had a prognostic value. Decompensation of the clinical course of HIV infection with a detectable HIV viral load and a decrease in CD4 + <500 pl-1 in the blood, the absence of ART and follow-up by a specialist at the Moscow city center for prevention and control of AIDS in most cases (89%) caused a severe clinical course of COVID-19.

Purpose: to evaluate clinical symptoms and laboratory parameters dynamics in patients with coronavirus disease-19 during hospitalization first week. Material and methods. The prospective study included 38 patients (21 women and 17 men) with moderate coronavirus disease-19. Questioning, clinical examination and laboratory parameters estimation were carried out. The European life quality questionnaire and health visual-analog scale (VAS) were used. General blood analysis was evaluated. Patients were examined at the hospitalization moment and after 7 days. Statistical analysis was carried out with Wilcoxon and McNemar's tests in critical p-value<0.050. Data were presented as median and quartiles. Results. Patients were hospitalized on average 7 (5+10) days after the disease onset. During the observation period there was decreasing number of patients' suffering from cough (from 27 to 21; p=0,041), breath shortness (from 15 to 8; p=0,045), anosmia (from 14 to 2; p=0,001), dysgeusia (from 10 to 2; p=0,027), weakness (from 30 to 17, p=0,002), headache (from 21 to 10; p=0,022), myalgia (from 11 to 3, p=0.013), nausea (from 9 to 3; p=0,041). Health general state improved from 60 (50+75) to 80 (55+87) points (p <0,001), discomfort feeling decreased from 2 (1+2) to 1 (1+2) points (p=0,025). During the week, hemoglobin concentration decreased from 137,5 (128,0+145,0) g/l to 125,5 (119,0+136,0) g/l (p <0,001) and the platelet count increased from 217,5 (179,0+279,0) 109/ l to 295,0 (235,0+367,0) 109/l (p=0,027). Conclusion. During the first week of hospitalization, weakness, headache, myalgia, breath shortness, cough, anosmia, dysgeusia, nausea regress, the hemoglobin level decreases, the platelet count increases moderately.

Aim: to present demographic, clinical, biochemical and virological parameters that characterize the course and progression of chronic hepatitis delta and subsequent fatal outcome in patients followed up over 10 years in endemic region of Russia (Republic of Tyva). Material and methods. Dynamic changes in clinical and laboratory parameters of 14 patients with fatal progression of chronic HDV infection were monitored from 2009 to 2019. Following parameters were monitored annually: the presence of detectable HBV DNA, HDV RNA, quantitative levels of HBsAg in blood serum, levels of serum alanine (ALT) and aspartic (AST) aminotransferases, alkaline phosphatase (ALP), gamma-glutamyltranspeptidase (GGTP) and the content of total bilirubin. HDV and HBV genotypes were determined as well. Results. The average follow-up period was 5,5±3,3 years. 5 patients (36%) died in the same year or the next year after the first visit. During the follow-up period, 12 patients died from complications associated with decompensated liver cirrhosis, and 2 patients with class C liver cirrhosis developed hepatocellular carcinoma with fatal outcome. The average number of years from inclusion in the study to the formation of LC and to fatal outcome was 3,7±2,3 years and 4,5±3,25 years, respectively. Average ALT and AST levels in patients exceeded the upper limit of normal (ULN) 1,8 and 1,6 times, respectively. The average values of GGTP, alkaline phosphatase, and total bilirubin did not exceed >3 ULN. The dynamics of HBsAg levels in the blood serum were unstable and varied from a minimum value of 3,3 lg IU/ml to a maximum of 5 lg IU/ml. All patients were infected with genotype 1 HDV and were positive for HDV RNA throughout the observation period. In 11 patients, the HBV genotype D was detected, in three patients the HBV genotype was not determined. 9 patients had undetectable levels of HBV viremia throughout the observation period. The proportion of such patients (64,3%) was significantly higher than the proportion of patients with HBV viremia (p <0,05, Fisher's exact test). Conclusion. Along with objective pathogenetic factors, late diagnosis and the lack of available therapy determine the high mortality rate in hepatitis delta patients.

Material and methods. 112 patients with complete long-term intraventricular block were included in the observational study. 84 patients had a history of prior myocardial infarction and chronic heart failure with preserved ejection fraction, 28 had no coronary history. All participants had an ambulatory ECG monitoring and coronary angiography. Patients were divided into four groups: 1 - single-vessel coronary artery disease (CAD); 2 - two-vessel CAD; 3 - three-vessel CAD; 4 - normal coronary arteries (control group). Results. The QTd and QTcd parameters measured at rest were significantly different in the groups (p <0,001 for both parameters) being higher in group 3 (three-vessel CAD) compared to the others. A comparative analysis of QTd and QTcd at maximum heart rate, as well as QTdD and QTcdD, revealed significant differences between the groups with the maximum values recorded in patients with one-vessel CAD. The median QTd at maximum heart rate was 67 ms in group 1 (vs 34 ms in control group and 50 ms in group 3; p <0,001 in both cases), the median QTcd was 77 ms (vs 39 ms in control group and 52 ms in group 3; p <0.001). The results of a correlation analysis demonstrated a significant inverse correlation between the QTd values at the maximum heart rate and the number of affected vessels (p = -0,706; p <0,001), as well as between the QTcd at the maximum heart rate and the number of affected vessels (p = -0,818 ; p <0,001). Dependence of the number of affected vessels on the QTcd at maximum heart rate was described by the following equation: Y = 4,81 - 0.043 x XQTcd, where Y was the number of affected vessels (from 1 to 3), XQTcd was the QTcd measured at maximum heart rate. Conclusion. The use of QTd and QTcd parameters represents a new opportunity in ECG diagnostics of stable CAD in patients with complete intraventricular block.

An important role for the course and outcome of bacterial purulent meningitis (BPM) is the timely diagnosis and early hospitalization of patients in a specialized hospital. The problem of early clinical diagnosis of BPM at the prehospital stage is primarily due to the similarity of clinical symptoms with a number of other acute CNS lesions and can lead to diagnostic errors, delayed profile hospitalization and an increase in the number of patients with severe course. The use of algorithms for the diagnosis of BPM at the primary stage allowed to improve the quality of prehospital care for patients. The number of patients with BGM delivered by SMP teams to non-infectious hospitals in 2019 decreased by 55,4% compared to 2017, in the group of children by 88%, which had a positive effect on reducing the number of complications, deaths, and adverse consequences of BPM.

The lecture identifies the key signs of acute respiratory infections. Differential diagnostic criteria for viral and bacterial lesions of the respiratory tract are presented. The principles of treatment of acute respiratory infections are defined.

The aim of the study: to assess the prophylactic efficacy of the Polyoxidonium in healthcare workers working with patients with COVID-19. Material and methods. The study included 913 medical staff working in the «red zones» of hospitals. The main group included 577 people who received Polyoxidonium tablets 12 mg (under the tongue) once a day for 30 days. Control group included 366 people who did not receive any prophylactic drugs. The number of ARI and COVID-19 diseases was assessed for 2 months (within 1 month of taking the drug and 1 month after taking the drug) by interviewing medical personnel using specially prepared questionnaires. To assess the duration of the effect of taking the drug, the second wave of the survey was conducted, in which the number of cases of ARI and COVID-19 was assessed during the period of taking the drug and within 3 months after the end of taking the drug. The second wave of the survey involved 350 health workers from those who took part in the first wave of the survey. Of these study 115 participants, 247 people took Polyoxidonium, 103 people did not take any medications. Results. With the use of Polyoxidonium, a significant decrease in the number of cases of ARI and COVID-19 was recorded compared to the control group. According to the data of the first wave of the survey, 0,7% of the participants in the main group fell ill with ARI, and 0,3% of COVID-19. In the control group, 12,2% fell ill with ARI, 5,1% - COVID-19. According to the second wave of the survey, 13,1% of participants in the main group fell ill with ARI, and 2,4% of COVID-19. In the control group, 57,3% fell ill with ARI and 26,2% with cOvID-19. In the main group, none of the participants contracted pneumonia, while in the control group, pneumonia was noted in 42,5% of ARI cases. In addition, the use of Polyoxidonium significantly reduces the number of cases of ARI and COVID-19 in medical workers suffering from chronic diseases (0,3% of participants had ARI and COVID-19 in the main group, in the control group 28,1% and 9,9% of participants had ARI and COVID-19 respectively). 86,9% of the surveyed medical workers considered the prevention with the help of Polyoxidonium effective and 88,2% of the respondents would like to continue it. Conclusion. The use of Polyoxidonium in medical workers has led to a significant decrease in cases of ARI and COVID-19, pneumonia. The use of Polyoxidonium probably contributes to an easier course of the disease in case of its onset.

The present review highlights the place and role of the cytoprotector trimetazidine in the current clinical recommendations for the treatment of chronic forms of CHD, the features of the mechanism of action, pharmacokinetics and advantages of this drug. The results of studies on the efficacy and safety of trimetazidine in clinical practice were analyzed.

Article highlights the role of B group vitamins (including B12 vitamin) in the treatment of patients with diabetes mellitus (DM) and diabetic polyneuropathy. The importance of diagnostics and treatment of cardiac autonomic neuropathy, neglecting of which could be as both a factor aggravating the course of diabetes mellitus and a cause of fatal cardiovascular outcome, has been updated. Possible mechanisms of the development of vitamin B12 deficiency in elderly patients and patients with diabetes mellitus are analyzed in details. Aspects of the cyanocobalamin influence at the immune status of a person, data on mortality among diabetes mellitus patients who have undergone COVID-19, as well as the possibility of using the combined Neuromultivit medicine containing B1, B6 and B12 vitamins and produced both in injectable and tablet form, are considered.

Pain in the cervical spine, upper extremities and shoulder remains an actual problem of modern medical clinical practice. The creation of a multidisciplinary model of CANS (Complaints of the Arm, Neck, and Shoulder) made it possible to unify the classification and diagnosis of these pain syndromes. In CANS therapy, it is advisable to use combination therapy, including NSAIDs and B vitamins. Medications Neuromultivit and Neurodiclovit have established themselves as effective medications in the treatment of neuropathic and nociceptive pain syndromes. Thus, their use is justified in the treatment of non-specific and specific CANS as primary and adjuvant therapy.

In an editorial on the current topic - treatment and prevention of new coronavirus infection, the rationale for using evidence from Cochrane Systematic Reviews to make evidence-informed decisions in practical medicine is justified. The editorial refers to the results of a recent Cochrane Review on chloroquine and hydroxychloroquine in COVID-19, which concludes that hydroxychloroquine does not reduce mortality from COVID-19 and does not reduce the need for mechanical ventilation, with more adverse effects than placebo.