The subacute period of coronavirus infection is a 4- to-12-week period after acute illness associated with the SARS-CoV-2 infection. A range of bronchopulmonary symptoms in the subacute period of COVID-19 includes cough, shortness of breath, reduced exercise tolerance, which, in turn, worsens the patient’s quality of life. Despite all the achievements of modern medicine, there is still no exact understanding of the mechanisms of this condition. There are also limitations of current patients’ treatments. The successful use of exogenous surfactant in the acute period of SARS-CoV-2 infection has become the starting point in the search for new therapeutic tools for this category of patients. The paper describes a clinical observation with the use of inhaled therapy with surfactant 150 mg/day for 7 days in a patient who underwent COVID-associated pneumonia with persistent ventilation disorders, decreased exercise tolerance, and characteristic changes identified due to the multispiral computed tomography examination. The treatment included the use of the Russian-manufactured surfactant (tauractant), a lyophilisate for suspension for endotracheal, endobronchial and inhalation administration, 75 mg vials. The drug is sourced from bovine lungs, refers to ATC R07AA30 (therapeutic combinations comprising pulmonary surfactants); pharmacotherapeutic group: surfactant. The studied treatment demonstrated the efficacy and safety of administration in this category of patients, and also ensured the disease control and improved quality of life.
Aim To evaluate functional changes in the heart in the long-term following COVID-19 in patients with chronic heart failure (CHF).Material and methods Case reports of 54 patients aged 69.1±9.7 years who had COVID-19 from January 2021 through January 2022 and had been previously diagnosed with NYHA functional class II-III CHF were studied. Two comparison groups were isolated: HF with LV EF >50 % (n=39) and <50 % (n=15). Echocardiography was used to evaluate changes in LV EF and pulmonary artery systolic pressure (PASP) 5-6 months following COVID-19.Results In all CHF patients after COVID-19 at 5.8 months on average, LV EF decreased (median difference, 2.5 %; 95 % confidence interval (CI): 6.99×10–5– 4.99) and PASP increased (median difference, 8 mm Hg; 95 % CI: 4.5–12.9). In the HF group with LV EF <50 %, the decrease in EF was greater than in the group with LV EF >50 % (6.9 and 0.7 %, respectively; p=0.037); furthermore, the CHF phenotype did not influence the change in PASP (p=0.4). The one-factor regression analysis showed that the dynamics of LV EF decrease was significantly influenced by the baseline decrease in LV EF, whereas the change in PASP was influenced by the dynamics of LV EF decrease, presence of dyslipidemia, and statin treatment. Furthermore, the multifactorial analysis showed that prognostically significant factors for long-term changes in LV EF following COVID-19 were male gender (odds ratio (OR), 5.92; 95 % CI: 1.31–26.75; p=0.014), LV EF at baseline <50 % (OR, 0.88; 95 % CI: 0.8–0.96; p<0.001); changes in PASP depended on the presence of dyslipidemia (OR, 0.08; 95 % CI: 0.01–0.84; p=0.018).Conclusion This study showed that COVID-19 in the long term can influence the course of CHF; in this process, HF patients with EF <50 % have progression of systolic dysfunction and PASP, whereas patients with EF >50 % have an isolated increase in PASP.
The problem of long COVID-19 (COronaVIrus Disease 2019) has been highly relevant for the healthcare system in the last three years. The persistence of respiratory symptoms, radiological and functional changes in COVID-19 patients brings new challenges to the entire medical community. The aim of the study is to explore long-term clinical and functional changes in patients with severe COVID-19-associated lung injury, including assessment of functional and radiological abnormalities of the respiratory system, as well as persistent clinical symptoms a year after the acute phase of the disease. Methods. The study included 45 patients who were examined 3, 6 and 12 months after COVID-19 with severe lung damage (more than 50% according to chest CT in the acute phase of the disease). Patients underwent multispiral computed tomography of the chest organs, a comprehensive study of respiratory function (spirography, body plethysmography and diffusion test); the clinical symptoms were assessed. Results. Chest CT scans showed gradual regression of pathological changes during the follow-up. However, radiographic changes of varying severity persisted after 12 months of follow-up in 51% of patients. A year later, restrictive disorders persisted in 20% of patients and the diffusion capacity of the lungs was reduced in 69% of patients. At the same time, a statistically significant difference in the DLСО level was observed between 3, 6 and 12 months. The severity of dyspnea decreased 1 year after hospitalization in 48% of patients. Conclusion. The obtained results demonstrate a gradual regression of both radiological and functional pathological changes during the 1st year. However, CT changes and deviations of the respiratory function persist in some patients, mainly in the form of a decrease in DLСО, which necessitates further monitoring of this group of patients.
The article presented a clinical case of 8-year follow-up of a patient with a relatively beneficial course of pulmonary sarcoidosis and intrathoracic lymph nodes and with gradually progressing myocardial injury. A specific feature of the case was that the patient had monoclonal gammopathy, which is extremely rarely reported. Morphological signs of paraproteinemic hemoblastosis and amyloidosis were not observed. The article considered a whole complex of studies, which is required for diagnosing cardiac sarcoidosis in a specific patient and addressed the issue of monoclonal gammopathy origination.
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