Vol 26, No 1 (2022)

The review includes an analysis of the latest literature data on the etiotropic therapy of a new coronavirus infection. The search for an effective antiviral treatment for SARS-CoV-2 infection is ongoing. Often, the urgent need for an antiviral drug was a pretext for testing drugs without pharmacological justification, bypassing the generally accepted procedure for conducting multi-stage clinical trials. In this regard, many clinical trials involving thousands of patients did not demonstrate the high efficacy and safety of drugs that were chosen as etiotropic therapy. In this review, we focused on the efficacy and safety of those drugs that have been studied in sufficient detail, which are reflected in international publications, and are also included in Russian guidelines for use on an outpatient practice: favipiravir and molnupiravir. The mechanism of action of antiviral drugs, their effectiveness and possible side effects were studied in clinical trials, the results of which are in the open press, which made it possible to analyze these drugs in terms of the appropriateness of their use in real clinical practice.

BACKGROUND: Vaccination is currently considered the most successful strategy against the SARS-CoV-2 virus. However, cases of infection despite vaccination, so-called breakthrough infections, have been reported worldwide.

AIM: To evaluate the impact of vaccination against the new coronavirus infection COVID-19 on the morbidity of university students.

MATERIALS AND METHODS: The incidence of new coronavirus infection (COVID-19) among the students of North-Western State Medical University named after I.I. Mechnikov (further University) from September 1 to December 15, 2020 and 2021 was analyzed. There were 4876 and 4681 students under observation. Data on vaccination, probable site of transmission infection were collected by interviewing the ill people. Statistical processing of data was performed using EpiInfo software.

RESULTS: For the analyzed period 191 cases of COVID-19 among students were detected, the incidence of COVID-19 was 4.08 per 100 students, for the same period of the academic year 2020 it was 5.50, despite the fact that the incidence among St. Petersburg residents in 2021 was 1.75 times higher than in 2020. Re-infection was detected in 35 (18.3%) cases, 18 of whom were also vaccinated against COVID-19. A probable place of transmission infection was established in 36.1% of the cases, the most frequent being contact with a patient at their place of work in a health-care facility. By December 15, 2021, a total of 62.8% of students had been vaccinated against COVID-19. The incidence among vaccinated students was 2.72 per 100 students and 4.94 per 100 among unvaccinated students. A risk factor for breakthrough infections after vaccination was close contact with the source of infection: vaccinated persons had close contact in 50% of cases, compared with 28.9% of unvaccinated persons. The most important were contact with a patient in a health care setting and having multiple sources of infection, 31.1% and 5.6%, respectively.

CONCLUSIONS: Vaccination against COVID-19 was an effective preventive intervention. A risk factor for disease after vaccination is close contact with the source of infection. Establishment of collective immunity after vaccination is decisive for the vaccination-to-disease ratio, which starts to develop with 70-80% of vaccinated individuals. The use of a mask in public places and social distancing remain important preventive measures.

Bisphosphonates are one of the most effective medications widely used in the treatment of osteoporosis. In the last 15 years, descriptions, and observations of unusual low-energy femoral fractures with atypical localization for osteoporosis after prolonged use of these drugs have been published.

A 78-year-old patient applied to the osteoporosis center. She received parenteral bisphosphonate therapy for severe osteoporosis for 4 years. In 2017, a spontaneous fracture of the middle third of the femoral shaft was registered (the fracture occurred while walking). Regarding the fracture, metal osteosynthesis with a plate was performed. Subsequently, there was a delayed consolidation of the fracture with the formation of a false joint and the need for repeated surgical intervention. Examination of the patient revealed vitamin D deficiency, and significant negative trend in densitometry.

A feature of this case is poor fracture consolidation and long-term uncompensated vitamin D deficiency. Physicians should be aware of this rare but serious complication of bisphosphonate therapy, as it requires discontinuation of antiresorptive drugs and the appointment of bone anabolic therapy for osteoporosis, which, in addition to treating the underlying disease, also promotes consolidation fracture.

On December 10, 2021, an International conference dedicated to the Universal Health Coverage (UHC) Day was held at the Al Farabi Kazakh National University. The purpose of the conference was to support and develop the main ideas of the UHC. The conference was attended by more than 100 representatives of universities and the medical community from Kazakhstan and other countries of the Commonwealth of Independent States (Russia, Ukraine, Belarus, Kyrgyzstan, Uzbekistan, Tajikistan, Azerbaijan). The reports of the conference participants were devoted to the discussion of global problems of the development and strengthening of primary health care and the achievements of UHC both at the level of the WHO European Region and in individual CIS countries. The issues of training doctors for primary health care, the successes, and prospects of the development of the primary health care system, issues of assessing and improving the quality of medical care, approaches to providing HEU during the COVID-19 pandemic were highlighted.

The conference resolution noted the need to consider the principles of the UHC when developing and making proposals to regulatory documents, initiate scientific research in the field of development and effectiveness of PHC models in the CIS countries, review educational programs for the training of PHC specialists taking into account the ideas and principles of HEU. It was also decided to hold an annual International conference “UHC: Opportunities and challenges”, to carry out joint publications on HEU at the country and regional levels.