A 74-year-old Asian female with a history of hypertension and chronic obstructive pulmonary disease was admitted to hospital for coughing, shortness of breath and fatigue; her nasopharyngeal swab was positive for COVID-19. Lopinavir/ritonavir 800mg/200 mg, daily was started. On the third day of antiviral therapy, the patient complained of dizziness, nausea, she was disorientated, and electrocardiogram showed sinus arrest, junctional escape rhythm 36 beats per min. Patient was successfully treated by temporary pacemaker, normal sinus rhythm was reverted on a 3rd day after stopping the lopinavir/ritonavir treatment. She was discharged home in stable condition. Bradyarrhythmia in form of sinus arrest can develop during treatment with lopinavir/ritonavir. The temporal nature of the observed changes and the ECG finding suggests the use of L/R contributed to the changes. This case highlights off-label prescribing lopinavir/ritonavir outside of a clinical trial setting should be avoided until the data have proven that treatment benefit over placebo.
Оценка качества жизни пациентов с хроническим вирусным гепатитом С на этапе непосредственного вирусологического ответа противовирусной терапии. В исследование были включены 105 пациента, страдающих хроническим вирусным гепатитом С (ХВГС), которым была назначена комбинированная противовирусная терапия в течении 12 недель (софосбувир 400мг + даклатасвир 60мг) Оценка физического и психологического состояния проводилась с помощью опросника SF-36 в момент включения в исследования (0), на 4 и на 12 неделе проведения терапии. Статистическая обработка результатов проводилась с использованием программы Statistica 10. В исходных данных снижение показателей качества жизни ниже нормального 50-бального порогового уровня отмечали почти по каждой шкале, кроме шкалы «Ролевое функционирование, обусловленное физическим состоянием», где результат составил 50 [0-75], что соответствует пороговому значению. Сравнив качество жизни пациентов в разные периоды проведения комбинированной противовирусной терапии, мы установили, что показатели всех шкал опросника SF-36 оказались достоверно (p≤0,001) выше у пациентов, получивших лечение, как по физическому, так и по психологическому ком-
The coronavirus disease COVID-19 began to spread worldwide in December 2019 from the city of Wuhan (China). COVID-19 is often accompanied by fever, hypoxemic respiratory failure and systemic complications (for example, gastrointestinal, renal, cardiac, neurological, and hepatic lesions), thrombotic phenomena. Central nervous system damage is caused by the primary effect on it, direct neuroinvasion of the virus, and more often by secondary effect due to systemic hyperinflammation. Neurological manifestations include fatigue, headache, insomnia, and olfactory/taste disorders. Neurological manifestations and complications of COVID-19 are diverse: (1) cerebral circulatory disorders, including ischemic stroke and macro/microhemorrhages; (2) encephalopathy; (3) para/postinfectious autoimmune complications, such as GuillainBarre syndrome; (4) meningoencephalitis; (5) neuropsychiatric complications (psychosis and mood disorders). In terms of pathogenesis, neurological disorders in COVID-19 can be caused by neurotropicity and neurovirulence of SARS-CoV-2, cytokine storm, hypoxemia, homeostasis disorders, as well as their combined effects. COVID-19 adversely affects the course and prognosis of chronic neurological disorders in comorbid patients. The review highlights the need for vigilance to early neurological complications in patients infected with SARS-CoV-2 and other coronaviruses, especially since some neurological complications may precede respiratory manifestations.
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