Background. Urinary tract infections remain one of the urgent problems in the aspect of qualified medical care. The causative agents of nosocomial infections are becoming more and more resistant to the drugs used, while the rate of new drugs synthesis is lower than the rate of development of antibiotic resistance. Routine and empirical prevention of recurrent urinary tract infections is often ineffective. Aim. To study the efficacy and safety of intravesical application of the drug based on bacteriophages in therapy in patients with chronic recurrent cystitis. Materials and methods. A clinical study was carried out to study the efficacy and safety of the drug for intravesical administration based on bacteriophages in therapy in patients with chronic recurrent cystitis. The study included 75 patients who were divided into 3 groups in a 1: 1: 1 ratio. In the main group, the drug for intravesical administration based on bacteriophages, as well as rectal suppositories with bacteriophages were used; in the control group only a drug for intravesical administration based on bacteriophages or rectal suppositories with bacteriophages. On visits 1-4, all patients underwent a clinical blood test, general urine analysis, bacteriological urine analysis, as well as urine analysis by the polymerase chain reaction method. The analysis of the patients condition in groups was carried out according to the dynamics of main clinical symptoms changes, data from validated scales for assessing pelvic pain and urgency/frequency of urination and assessment of symptoms of acute cystitis (Acute Cystitis Symptom Score ACSS), as well as the dynamics of changes in objective parameters of laboratory studies and possible changes in sensitivity uropathogens to antibacterial drugs. Results. The average age of the patients included in the study was 50.6 years. In all 3 groups, bacteriological examination of urine showed a predominant growth of Escherichia coli (3104 CFU/ml). In the course of the study, there was a good tolerance to therapy, a decrease in clinical symptoms, as well as a significant decrease in the total score according to the pelvic pain scale and urgency/frequency of urination and the ACSS scale in all patients. Conclusion. The emergence of a large number of microorganisms resistant to various antibiotics and their rapid spread in the environment has led to an increase in scientific interest in bacteriophage therapy as an alternative method of treatment. The overall subjective effectiveness of the therapy in our study was more than 80%, safety - 100%. Further research will allow for a personalized approach to the treatment of infectious diseases of the urinary system.
The new coronavirus infection pandemic has certainly changed all spheres of human activity, the healthcare system was completely transformed and reassignment in a short time. The built model of a personalized approach to each patient was replaced by the provision of health services to groups of patients with similar symptoms of the disease and severity, and conditions not associated with coronavirus infection, anyway, took a back seat. Since the announcement of the COVID-19 pandemic, the main human and material resources have been directed at combating the new infection. To date, almost every country has cases of coronavirus infection. The planned surgical care was temporarily stopped, what could not but affect the outcomes of diseases. A special category of patients is represented by patients with diagnosed malignant neoplasms, the delay in treatment of which can significantly reduce the life expectancy and/or quality of life. The current state of the problem served as a catalyst for the development of telemedicine technologies, which simplified communication in the patient-physician and physician-physician relationship. Urinary tract infections are one of the most common reasons for visiting a urologist, which implies the prescription of antibacterial drugs. However, in a pandemic, remote prescription of these drugs is limited by the lack of face-to-face specialist consultations. This enabled make it possible to use drugs based on bacteriophages. Patient management problems were solved by using distance counseling techniques. In this article we present an algorithm for providing urological and oncourological care to patients in the context of the COVID-19 pandemic, as well as an overview of the existing world practice in the implementation of telemedicine consultations in the current epidemiological situation.
Since the beginning of the COVID-19 pandemic, there have been a number of studies related to the impact of SARS-CoV-2 on the course of pregnancy and fetus condition. As observed, the placentas of women who have had a new coronavirus infection often contain more villous agglutination and subchorionic thrombi than placentas in SARS-CoV-2-negative women. To date, several isolated publications have reported clinical cases of fetal death in mothers infected with coronavirus infection. The authors have made an assumption on the association of adverse outcomes with placental lesions. The aim of the study was to analyse a clinical case of a moderate-course new coronavirus infection in a pregnant woman at a long gestation period who underwent an antenatal fetal death, and evaluate the features of placental histopathology and their impact on adverse gestational outcomes. Material and methods. The authors have analysed Russian and international research publications from various sources, including eLIBRARY.RU, CyberLeninka, PubMed databases etc. and, considering the data obtained, investigated a clinical case of intrauterine fetal death in a pregnant woman infected with SARS-CoV-2. The placenta was studied in accordance with the clinical recommendations of the Russian Society of Pathologists "Rules for placental pathological and anatomical examination" and the international classification of placental lesions (Amsterdam, 2015). Results. The results obtained support the association between acute diseases of the upper respiratory tract and developing severe hemodynamic disorders in the "mother-placenta-fetus" system in pregnant women infected with SARS-CoV-2. Systemic inflammation associated with new coronavirus infection appears to be one of the mechanisms for developing placental disorders.
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