The aim of the work was to justify the algorithm of outpatient drug therapy in patients with COVID-19, based on the principle of «Multi-hit» Approach. The algorithm is based on the published results of clinical studies and observations, authors’ own practical experience in the use and management of more than 4 thousand patients diagnosed with COVID-19 of varying severity during the 2020 pandemic. The article substantiates a complex algorithm for the treatment of outpatients with COVID-19, which includes etiotropic, pathogenetic, and symptomatic components of therapy with different mechanisms of action. The described approach is the 1st stage (outpatient) of a complex algorithm for managing patients with COVID-19. It has been successfully implemented in the system of outpatient care for patients with novel coronavirus infections in several leading medical institutions in Russia. The authors believe that the developed algorithm for providing outpatient drug therapy for COVID-19, based on the principle of multiple exposure, may be useful in real clinical practice of managing patients with coronavirus infection.
Цель. Изучение летальности и факторов риска смерти больных с COVID-19, госпитализированных для респираторной поддержки в отделения реанимации и интенсивной терапии (ОРИТ) лечебных учреждений Российской Федерации. Материал и методы. Ретроспективное исследование было выполнено в Федеральном дистанционном консультативном центре анестезиологии и реаниматологии для взрослых пациентов с COVID-19 на базе Первого МГМУ им. И.М. Сеченова. В исследование включали всех пациентов с известными исходами (смерть от любых причин или выздоровление) SARS-CoV-2 пневмонии, осложнившейся острым респираторным дистресс синдромом (ОРДС), которые были проконсультированы с 16 марта по 3 мая 2020 г. Факторы риска смерти анализировали с помощью многофакторной регрессионной модели Кокса. Результаты. В исследование были включены 1522 пациента, 864 (56,8%) мужчины и 658 (43,2%) женщин. Медиана возраста-62 года. 922 (60,6%) больных находились в ОРИТ стационаров Москвы и Московской области, 600 (39,4%)-лечебных учреждений в 70 регионах Российской Федерации. У 995 (65,4%) больных диагноз SARS-CoV-2 инфекции был подтвержден с помощью ПЦР. Умерли 995 (65,4%) пациентов, выжили 527 (34,6%). Основными причинами смерти были ОРДС (93,2%), сер
А ртериальная гипертония (АГ) является одной из актуальнейших проблем современного здравоохранения, поскольку она ассоциируется с повышенным риском развития осложнений-мозгового инсульта, инфаркта миокарда, хронической сердечной недостаточности (ХСН) и хронической болезни почек. Данные состояния служат причиной приблизительно 9,4 млн смертей во всем мире ежегодно, причем среди всех смертей от сердечно-сосудистых заболеваний на долю осложнений гипертонической болезни (ГБ) приходится 45 %, а в структуре общей
Over the two years of the novel coronavirus infection (COVID-19) pandemic, there has been an evolution of views in various fields of medicine, which has led to a powerful development of scientific research in the field of epidemiology, clinic, diagnosis and therapy of COVID-19. The article highlights the evolution of views and approaches to the study of the epidemiology and radiology of COVID-19. The data of molecular genetic studies are shown, which are the most important component of epidemiological surveillance. The study of the manifestations of the COVID-19 epidemic process made it possible to distinguish two stages in the development of the epidemiological situation in the Russian Federation. At the first stage of the epidemic, two rises in the incidence rate of the population were recorded, regulated by social and natural factors. The second stage of the epidemic was due to a change in the biological properties of the SARS-CoV-2 virus, followed by a change in the prevailing genovariants (Alpha, Delta and Omicron). At the second stage of the epidemic, three rises in the incidence of the population were recorded. The general principles for the use of radiodiagnosis methods, which are used primarily to detect lung damage in COVID-19, are given. With the accumulation of experience, a natural change in ideas about the algorithms for the use of visualization technologies has occurred.
Despite advances in vaccine development, influenza remains a persistent global health threat and the search for a broad-spectrum recombinant vaccine against influenza continues. The extracellular domain of the transmembrane protein M2 (M2e) of the influenza A virus is highly conserved and can be used to develop a universal vaccine. M2e is a poor immunogen by itself, but it becomes highly immunogenic when linked to an appropriate carrier. Here, we report the transient expression of a recombinant protein comprising four tandem copies of M2e fused to an artificial self-assembling peptide (SAP) in plants. The hybrid protein was efficiently expressed in Nicotiana benthamiana using the self-replicating potato virus X-based vector pEff. The protein was purified using metal affinity chromatography under denaturing conditions. The hybrid protein was capable of self-assembly in vitro into spherical particles 15–30 nm in size. The subcutaneous immunization of mice with M2e-carrying nanoparticles induced high levels of M2e-specific IgG antibodies in serum and mucosal secretions. Immunization provided mice with protection against a lethal influenza A virus challenge. SAP-based nanoparticles displaying M2e peptides can be further used to develop a recombinant “universal” vaccine against influenza A produced in plants.
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