Ozone therapy as a component of a comprehensive rehabilitation program for patients after polysegmental pneumonia associated with SARS-CoV2 infection

Aim: to analyze the effectiveness of intravenous ozone therapy in long COVID-19 patients experienced community-acquired polysegmental pneumonia (associated with SARS-CoV2 infection). Materials and methods. The study involved 42 long COVID-19 individuals aged 41–82 years who underwent rehabilitation after community-acquired polysegmental pneumonia associated with SARS-CoV2 infection. The patients were examined and followed up subjectively (by the G. Borg and PCFS scales) and objectively (oxygen saturation, C-reactive protein, ferritin, D-dimer, urea and creatinine, 6-minute walk test). All patients received similar medicamentous therapy, and combined intravenous ozone therapy was additionally prescribed to the main group patients (n = 21): an alternate-day infusion of 200 ml ozonized saline at a concentration of 20 mg/ml and major autohemotherapy (100 ml ozonized saline at a concentration of 30 mg/ml mixed with 100 ml of the patient’s blood), 10 sessions per treatment course. Results. The integrated approach to the complex program of long COVID-19 treatment and rehabilitation for patients after pneumonia associated with SARS-CoV2 infection using intravenous ozone therapy has demonstrated its significant effectiveness based on the objective and subjective findings (P < 0.01). Twice as many patients in the main group (n = 18) achieved endpoints of the study (absence of dyspnea, normalization of blood biochemical markers and oxygen saturation levels, restoration of exercise tolerance) as compared to the control group (n = 9). Conclusions. The use of combined intravenous ozone therapy (alternating infusion of ozonized saline and ozonized saline mixed with the patient’s blood) in the rehabilitation program for patients after experienced community-acquired polysegmental pneumonia associated with SARS-CoV2 infection is pathogenetically substantiated, effective and cost-effective addition to complex health recovery tools.

Heart rhythm and autonomic regulation disorders in chronic coronary syndrome patients with community-aсquired pneumonia

Pneumonia presents a considerable challenge in patients with cardiovascular disease due to an increase in the incidence, difficulties of diagnosis and treatment, high mortality. Aim: to study the characteristics of cardiac arrhythmias and heart rhythm autonomic regulation in patients with chronic coronary syndrome (CCS) and community-acquired pneumonia (CAP), and to define their relationship with the clinical features of the disease. Materials and methods. A monocenter cross-sectional study analyzed 90 patients with CCS in parallel groups. The main group included 60 CCS patients with CAP; the control group consisted of 30 patients without concomitant CAP. A complex clinical examination of patients was performed on 1–3 days of hospital stay in accordance with the National Recommendations. Holter ECG monitoring was performed using a CARDIOSENS K device (XAI-MEDICA, Ukraine). Results. Based on the results of 24-hour ECG monitoring, heart rhythm disorders, increased duration of myocardial ischemia and ST-segment depression depth with an increase in the total duration of tachycardia episodes within 24 hours were more common in the main group patients. The severity of CAP on the PSI/PORT scale was correlated with the 24-hour mean heart rate (r = +0.31, P < 0.05), the number of ventricular extrasystoles – with respiratory rate (r = +0.29, P < 0.05), supraventricular extrasystoles – with the duration of ST-segment depression (r = +0.57, P < 0.05). In patients with CCS and CAP, there was a decrease in the total heart rate variability (HRV), mainly in the passive period, combined with an increase in the LF/HF ratio and stress index (SI), which was directly correlated with the severity of CAP and intoxication syndrome. Conclusions. Patients with CCS and CAP are characterized by the increased 24-hour heart rate, duration of ST-segment depression, frequency of supraventricular and ventricular arrhythmias on 24-hour Holter monitoring, paroxysms of atrial fibrillation with the decreased total HRV combined with significantly increased activity of the sympathetic autonomic nervous system.

Current state of treatment for lower extremity acute deep venous thrombosis (a literature review)

Despite the use of modern methods of diagnosis and treatment, deep vein thrombosis (DVT) of the lower extremities remains a fairly common disease. In half of all cases, DVT may be asymptomatic and manifest itself in subsequent symptoms of pulmonary embolism (PE) or postthrombotic syndrome (PTS). An important role in the pathogenesis of this disease is played by a variety of factors and conditions that contribute to thrombosis in the venous vessels of the lower extremities, as well as impaired venous outflow from the lower extremity due to blockage of the venous lumen by such a thrombus. The action of various treatments is aimed at certain links in the pathogenesis, namely: anticoagulant therapy prevents further thrombosis, thrombolysis dissolves blood clots, surgical and mechanical thrombectomy remove blood clots from the lumen of the vein, lysis or removal of thrombotic masses restores thrombosis in the small circle of blood circulation. There is no single, universal method for combating DVT. In addition, there are new methods, such as the use of devices for pharmaco-mechanical thrombolysis, stent-retrievers which need to be tested for effectiveness and safety, as well as for a comparative analysis with existing treatments. Given the severe consequences of DVT that include early mortality, recurrence and complications of the disease, and can be associated with death, rehospitalization, deterioration in patient quality of life and disability, the choice and application of certain treatments or combinations thereof becomes important. Equally important are the issues of primary and secondary prevention of DVT, which reduce the above-mentioned risks and should be pursued in each patient. The aim. To study the world experience in the treatment of DVT, to summarize modern approaches to the treatment of patients with DVT based on the principles of evidence-based medicine by reviewing and analyzing modern scientific literary sources in scientometric bases. Materials and methods. We searched for publications in scientometric databases including Pub Med, Google Scholar, Web of Sciense, Scopus by keywords, as well as for the latest recommendations and guidelines that cover modern methods of diagnosis and treatment of DVT of the lower extremities. Articles, systematic reviews and literature relevant to the research topic were reviewed and analyzed. The inclusion criteria were: articles and studies describing to the pathophysiology, diagnosis and treatment of DVT, studies with the longest observation, recommendations and guidelines of professional associations regarding DVT. The exclusion criteria were: articles not related to the research topic, a small number of patients included in the study (less than 15 people). Conclusions. DVT and its complications can lead to fatal conditions, such as pulmonary embolism, and often adversely affect patients’ quality of life. DVT is potentially life-threatening and should be considered by a physician and patient as a life-threatening disease. Anticoagulant therapy is the main option for both DVT treatment and secondary prevention of venous thromboembolism and PTS recurrence. Some patients may receive drug therapy on an outpatient basis. Other patients with severe disease and complications need inpatient management. An open surgery, percutaneous endovascular procedures and various combinations thereof with the addition of anticoagulant therapy could be applied to this group. The lack of clear criteria for selecting patients and indications for endovascular interventions and surgical thrombectomy requires further research in this area.

Prognostic value of pharmacotherapy in patients with atrial fibrillation after radiofrequency ablation

The aim of the work: to evaluate the prognostic effect of pharmacotherapy before and after radiofrequency ablation (RFA) in patients with atrial fibrillation (AF) on all-cause mortality, supraventricular arrhythmia recurrence and non-fatal cardiovascular events. Materials and methods. Patients with paroxysmal, persistent and long-term persistent forms of AF were examined before and after RFA – isolation of pulmonary veins. The primary endpoint was patient survival, secondary – a composite endpoint of freedom from recurrence and/or non-fatal cardiovascular events for 2 years of a follow-up. Frequency and doses of pharmacotherapy were evaluated. Standard statistical procedures were used for initial data evaluation. Results. 116 patients were consecutively enrolled in the study. In the long-term post-ablation, 23 patients (19.8 %) continued to take amiodarone, 2 patients (1.7 %) – propafenone for arrhythmic events, 38 patients (32.8 %) needed anticoagulants, and 37 patients (31.9 %) received beta-adrenoceptor blockers over the entire follow-up period. The use of RAAS inhibitors decreased from 81.0 % before the ablation to 56.0 % in the long-term period following RFA. Multifactorial logistic regression analysis showed that the prolonged (more than 3 months) anticoagulation (P = 0.032) after RFA was an independent predictor of patient survival in the two-year follow-up; doses of anticoagulants before the procedure, use and doses of beta-adrenoceptor blockers in the long-term post-ablation period were associated with the secondary endpoint. Conclusions. RFA for AF significantly reduced the frequency of medications use in the long-term postoperatively. Independent predictors of survival were the doses of anticoagulants more than 3 months after ablation, arrhythmia recurrence and non-fatal cardiovascular events – the doses of anticoagulants before the procedure, and the use and doses of beta-adrenoceptor blockers in the long-term period after RFA.

Criteria for selection of patients with lumbar intervertebral disc herniation complicated by spinal canal stenosis

Aim – to evaluate clinical and instrumental correlation (MRI data) in patients with lumbar intervertebral disc herniation complicated by spinal canal stenosis for optimizing the indications for differentiated surgical treatment. Materials and methods. Clinical and neurological manifestations and MRI data in 80 patients (men – 36, women – 44), aged 27 to 72 years with a diagnosis of intervertebral disc herniation complicated by spinal canal stenosis were retrospectively analyzed. Depending on the size of the spinal canal, there were 2 groups: the first – with relative spinal canal stenosis (n = 20) – 75–100 mm2, and the second group – with absolute spinal canal stenosis (n = 60) – less than 75 mm2. We examined the correlation between the clinical and neurological presentations and MRI findings. Results. Our retrospective analysis has found that the first group consisted mainly of younger patients (46 years) and with a mean intervertebral disc herniation of 8.35 mm, while the second group included older patients (51.7 years) and the mean size of intervertebral disc herniation was 7.3 mm. The group of relative spinal canal stenosis was dominated by patients with radiculopathy syndrome (70 %) and pain in one lower limb (85 %). Radiculoischemia syndrome (50 %), pain in both lower extremities (33 %), neurogenic intermittent claudication syndrome (46.6 %), knee reflex disorders (58.3 %), pelvic organ dysfunction (11.6 %) were more common in the second group of patients. In addition, the longest disease duration (more than 24 months) was observed among patients of this group. We have found a relationship between pain syndrome (according to VAS), muscle strength, the disease duration and the spinal canal area. Conclusions. The correlation of clinical and instrumental methods of examination in patients with intervertebral disc herniation complicated by spinal canal stenosis allows the indications for differentiated surgery to be optimized.

Simulation of endothelium-dependent vasodilation in young male persons based on the parameters of body weight components

The aim of the work. To analyze the results of endothelium-dependent vasodilation of the brachial artery in persons with different content of body weight components and to develop models for predicting the response of endothelium-dependent vasodilation based on the parameters of body weight components. Materials and methods. In total, 31 young men were examined and divided into three groups depending on the total body fat value: 16 people (51.6 %) – group I, 11 people (35.5 %) – group II and 4 people (12.9 %) – group III. Determination of such parameters as body mass index (BMI, kg/m2), the percentage of total fat (TFP, %), the visceral fat content (VFC, units) and the content of free-fat mass (FFM,%) was performed using a bioimpedance analyzer TANITA BC-601. Endothelial regulation was assessed on the basis of vasomotor dilation of the brachial artery activity before and after the occlusion test using a four-channel rheograph ReoCom (XAI-MEDICA). Results. During the occlusion test, three types of endothelium-dependent vasodilation (EDVD) were identified in individuals exa­mined. 62.50 % of men in group I had a normoergic reaction of the brachial artery, 31.25 % had a hyperergic and 6.25 % had a hypoergic reaction. Among group II persons, a normoergic type of post-occlusive reaction was in 45.4 %, hyperergic – in 36.4 %, and hypoergic type – in 18.2 %. Regarding group III, 75 % of individuals had the hyperergic type of endothelium-dependent vasodilation, 25 % had the normoergic type, and no hypoergic type of reaction was observed at all. To determine the endothelial vasoregulatory function on the basis of correlation-regression analysis, models were constructed with coefficients of determination R2 of 0.277 (BMI), 0.126 (TFP), 0.189 (VFC) and 0.146 (FFM). The models themselves had the following form: between EDVD and BMI – y = -4.5297 + 0.865x; TFP – y = 10.7389 + 0.4x; VFC – y =13.8119 + 1.0041x; FFM – y = 52.7904 – 0.4464x. In addition, statistically significant correlations were found between them – from r = +0.335 to r = +0.526. Conclusions. The data obtained allow us to note that the functional state of the endothelium and its activity depends on the content of body weight components in the organism.

Incidence of cardiac arrhythmias in patients with COVID-19 infection according to 24-hour electrocardiogram monitoring

Cardiac arrhythmias in patients with COVID-19 infection may be due to many pathophysiological factors. Further study on the structure of arrhythmias in this category of patients will reveal clinically significant arrhythmias and select the optimal management. The aim: to determine the features of arrhythmias in patients with and without concomitant cardiovascular disease who suffered from COVID-19 infection based on the results of 24-hour electrocardiogram (ECG) monitoring. Materials and methods. 84 patients (45 men – 53.5 %, 39 women – 46.5 %) who had COVID-19 infection over 12 weeks previously were examined. Patients were divided into 2 groups – with and without a history of concomitant cardiovascular disease. The patient groups did not differ in age (P = 0.33) and sex (P = 0.58, P = 0.64). 24-hour ECG monitoring was performed on a Cardiosens K device (XAI-MEDICA, Kharkiv) according to the standard method. Results. Comparison of 12-channel ECG data did not reveal a significant difference in the incidence of single atrial (P = 0.13) and ventricular extrasystoles (P = 0.37) between the two groups, but sinus tachycardia was significantly more common in patients without concomitant cardiovascular disease (P = 0.022). According to 24-hour ECG monitoring, a significantly higher total number of arrhythmias, in particular, supraventricular extrasystoles (P = 0.009), high gradations of ventricular arrhythmias: paired ventricular extrasystoles (P = 0.041), ventricular bigeminy (P = 0.005), ventricular trigeminy (P = 0.004), ventricular salvos (P = 0.017) were detected significantly more frequently in patients with concomitant cardiovascular disease after COVID-19 infection than those in the comparison group. The results of 24-hour ECG monitoring also showed that patients without cardiovascular disease were significantly more likely to have inappropriate sinus tachycardia (P = 0.03) and postural orthostatic tachycardia (P = 0.04). Paroxysmal arrhythmias were significantly more common in patients with concomitant cardiovascular pathology, namely unstable (P = 0.002) and stable paroxysms of atrial tachycardia (P = 0.014), unstable paroxysms of monomorphic ventricular tachycardia (8.3 %), paroxysms of atrial fibrillation (6.2 %). Conclusions. 24-hour ECG monitoring should be advised in patients with COVID-19 infection and concomitant cardiovascular disease in addition to recording a standard 12-channel ECG to detect prognostically unfavorable cardiac arrhythmias, possible arrhythmogenic manifestations of post-COVID-19 syndrome and choose management tactics for these patients.

Morbidity analysis of pharmacists during the COVID-19 pandemic (a literature review)

The aim of the work is to analyze and summarize the literature data regarding the morbidity of pharmacists in the context of the COVID-19 pandemic and to determine the prospects for further research in this direction. Results. The catastrophic spread of the coronavirus infection (COVID-19) across the planet has become a challenge to the resilience of healthcare systems around the world. Pharmacists, as part of the healthcare professional team, have a unique role in the ongoing global fight against the pandemic. At the same time they are directly influenced by adverse environmental factors. Based on the literature data integration, it was determined that pharmacists are exposed to psychological stress, they are susceptible to allergic, oncological diseases, as well as diseases of the musculoskeletal system, and to primary varicose veins of the lower extremities. In addition, when providing pharmaceutical care, pharmacists may be at a very high risk for COVID-19. A review of scientific professional literature over the past 5 years has shown the lack of targeted research concerning the structure and level of morbidity with temporary disability of pharmacists in Ukraine and in other countries of the world. This fact and previously conducted studies give grounds to assert that there are significant difficulties in providing, collecting, accumulating and analyzing indicators of morbidity with temporary disability of pharmacists in Ukraine both at the state level and at the level of individual pharmaceutical enterprises. Today, we need to develop a methodology for assessing the relationship between the morbidity of pharmacists and their working conditions, and to find fundamentally new approaches to reduce the risk of COVID-19 infection. This should result in improvement of the working conditions in the pharmaceutical sector and in the health care sector in Ukraine. Conclusions. Analysis and summary of literature data on the morbidity of pharmacists in the context of the COVID-19 pandemic have revealed the need for further scientific research regarding the substantiation of factors affecting the structure and level of their incidence. The pandemic has created a need to develop scientifically based measures to increase the resilience of workers in the pharmaceutical health sector of Ukraine to the negative factors of the working environment impact on their life andhealth.

Comparative efficacy and predictive value of fixed combination of amlodipine and angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker in patients with coronary heart disease, post-infarction cardiosclerosis and hypertension

The aim of the work – to analyze the effectiveness of a fixed combination of amlodipine and angiotensin-converting enzyme (ACE) inhibitor (lisinopril) or angiotensin II receptor blocker (valsartan) in patients with coronary heart disease (CHD), post-infarction cardiosclerosis (PIC), arterial hypertension (AH) regarding the blood pressure (BP) control and impact on a composite endpoint. Materials and methods. General clinical examination of 108 patients with PIC and AH was done at the Cardiology Department of Shupyk National Healthcare University of Ukraine within 12 months. Patients were divided into two groups. The first group patients (n = 50) were assigned to receive a fixed combination of valsartan and amlodipine (160 mg and 5 mg, respectively), and the second group patients (n = 58) were treated with a fixed combination of lisinopril and amlodipine (10 mg and 5 mg, respectively). Patients were followed-up for 12 months, including general clinical examination, office BP measurements, 24-hour BP monitoring, echodopplerography, monitoring of the composite endpoint. Exclusion criteria were hemodynamically significant heart valve lesions, permanent or temporary cardiac pacing, acute heart failure and implanted cardioverter-defibrillator, permanent form of atrial fibrillation, acute cerebrovascular disorder, decompensation of severe somatic pathology. Statistical analysis of the data obtained was performed using Microsoft Excel, IBM SPSS Statistics v. 23. Descriptive data were presented as arithmetic mean ± standard deviation (M ± SD) in the case of normal distribution of variables, data with distribution other than normal were presented in Me format (Q25; Q75), where Me was the median, Q25, Q75 – lower and upper quartiles (Q25; Q75), or as a percentage for categorical values with Pearson’s Chi-square (χ2) calculation. Differences in mean values were considered statistically significant at a level of Р < 0.05. Results. According to all statistical criteria, BP indicators did not differ in both patient groups. Systolic office BP in the first group was 133.00 (123.00; 140.25) mm Hg., in the second group – 130.00 (122.00; 140.00) mm Hg. In the first group, diastolic office BP was 81.00 (79.50; 81.00) mm Hg and in the second group – 80.00 (75.00; 86.00) mm Hg. No statistically significant differen­ces were found in the study groups when assessing mean BP levels during the 24-hour monitoring. In the assessment of index values, systolic BP load was higher than normal in 58 % of patients in the first group and in 56.9 % of patients in the second group (χ2 = 0.01; P = 0.53). The assessment of diastolic BP load indices revealed increased diastolic BP index in 72 % of patient in the first group and in 75.9 % – in the second group (χ2 = 0.2; P = 0.4). The number of patients with BP higher or less than 130/80 mm Hg was compared. Systolic BP was above and below 130 mm Hg in 56 % and 44 %, respectively, of the first group patients; the distribution was 37.9 % and 62.1 % in the second group. Therefore, the percentage of patients with target systolic BP was higher in the second group (χ2 = 3.52; P = 0.046). Analyzing the composite endpoint, a statistically significant difference in the Kaplan–Meier curves via the statistical criterion using a log-rank test (P = 0.007) was detected. Conclusions. No statistically significant differences were found in the analysis of office blood pressure and 24-hour blood pressure monitoring between amlodipine with lisinopril and amlodipine with valsartan groups. The detailed analysis revealed a greater percentage of patients with target blood pressure below 130/80 mm Hg among those under 65 years of age receiving amlodipine with lisinopril (χ2 = 3.52; P = 0.046). The better prognostic value of the fixed combination of amlodipine with lisinopril compared to the combination of amlodipine with valsartan (P = 0.007) was demonstrated by the endpoint analysis.

Specifics of endovascular embolization for cerebral aneurysmsin the acute period of subarachnoid hemorrhage

Aim – to assess the benefits of modern methods for endovascular occlusion of ruptured cerebral aneurysms in the acute period of subarachnoid hemorrhage (SAН). Materials and methods. Medical records of patients undergoing treatment in the acute period of aneurysmal SAН between 2010–2021 were analyzed. 2 groups were formed: I – the use of standard surgical catheters, minimal use of adjunctive techniques for aneurysm embolization (2010–2016), II – routine use of triaxial access systems, intraarterial infusion of nimodipine, active use of adjunctive techniques for aneurysm embolization, intraoperative antiplatelet therapy immediately after aneurysm occlusion – 500 mg of solution Acelysin administrated intravenously (2017–2021). The severity of SAН according to the Hunt–Hess, Fisher scales, the treatment outcome according to the modified Rankin Scale (mSR), the location and size of aneurysms and intraoperative complications were analyzed. Results. There were 156 observations in group I, 91 – in group II. The median age was 48.26 years in group I, 51.44 years – in group II. On the basis of gender status, there was a majority of women in both groups. Aneurysms of the anterior cerebral-anterior communicating artery complex predominated in both groups; the internal carotid artery was the second most frequent localization. The severity of SAН according to the generally accepted scales (Hunt–Hess, Fisher) did not differ significantly. Coil embolization was used in 100 % of cases, balloon-assisted coiling was used in 6.48 % in group I and in 14.80 % – in group II, stent-assisted coiling – in 2.56 % and 9.30 %, respectively, distal access catheter with the triaxial system was not used in group I and it was performed in 57.4 % of cases in group II. Pharmacoangioplasty using nimodipine solution was used in 16.6 % in group I and in 22.2 % in group II. Intravenous drip infusion of 0.5 g Acelysin was performed immediately after aneurysm occlusion in 22.2 % of cases in group II. Intraoperative aneurysm rupture was observed in 5.1 % in group I and in 1.1 % in group II. Distal coil migration or into the maternal artery occurred in 6.41 % in group I and in 2.20 % in group II. Thromboembolic complications were noted in 7.69 % and in 2.20 %, respectively. The mean value of dysfunction degree on mSR amounted to 2.27 in group I and 1.45 – in group II. A good treatment outcome (mRS score 1–2) was defined in 71.2 % of observations in group I and in 87.9 % – in group II. The death rate was 12.82 % and 7.62 %, respectively. Conclusions. Routine use of triaxial access systems and intraarterial pharmacoplasty with nimodipine allow adequate prevention of mechanically induced vasospasm during catheterization of the aneurysm cavity. The triaxial access system stability provides better control of the microguidewire and microcatheters reducing the risk of aneurysmal wall perforation during catheterization. The use of adjunctive techniques for embolization of ruptured cerebral aneurysms in the acute period of SAH and prophylactic infusion of Acelysin solution after aneurysm occlusion significantly reduces the incidence of thromboembolic complications. The earliest possible occlusion of a ruptured cerebral aneurysm is not only the prevention of re-rupture, but also expands the possibilities of intensive care for preventing secondary complications of SAH.