Clinical management and treatment of patients with Covid-19 infection
Clinical management and treatment of patients with Covid-19 infection
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УДК 615.01
Clinical management and treatment of patients with Covid-19 infection
Kosykh Alexander Vyacheslavovich
Teacher, pharmacist-organizer,
clinical pharmacologist
FSBEI of HE «Stavropol State Medical University»Essentuksky branch
(Russia, Essentuki)
Email: alekskosyx@mail.ru
The article examines the issue of clinical management and features of treatment of patients with coronavirus infection. If Covid-19 is suspected, patients are required to be hospitalized in an infectious diseases hospital in compliance with all preventive measures. Treatment of patients with mild to moderate forms of the disease is carried out according to the treatment regimen for patients with influenza. Hospitalized patients with Covid-19 infection should be placed in boxes or single rooms. If necessary, intensive care of patients is delivered to the nearest ICU or ICU. All patients who do not have severe concomitant metabolic diseases (diabetes mellitus) and other acute conditions should receive food according to the 15th dietary table. Patients unconscious and on mechanical ventilation should receive appropriate parenteral nutrition. Supportive pathogenetic therapy should be included in the treatment regimen for patients with Covid-19 infection, and complications and adverse outcomes should be prevented. To prevent the spread of the disease, strict monitoring of compliance with the sanitary and epidemiological regime must be observed.
Key words: Covid-19, сlinical management, treatment of patients, infection.
Клиническое ведение и лечение больных с MERS-CoV инфекцией
Косых Александр Вячеславович
Преподаватель, провизор-организатор,
клинический фармаколог
ФГБОУ ВО «Ставропольский государственный медицинский университет» Ессентукский филиал
(Россия, Ессентуки)
Электронная почта: alekskosyx@mail.ru
В статье изучается вопрос клинического ведения и особенности лечения больных с коронавирусной инфекцией.
При подозрении на коронавирусную инфекцию пациенты подлежат госпитализации в инфекционный стационар с соблюдением всех профилактических мероприятий.
Лечение больных легкой и среднетяжелой формой заболевания проводится по схеме лечения больных гриппом. Госпитализированные больные с коронавирусной инфекцией должны размещаться в боксы или одноместные палаты. При необходимости проведения интенсивной терапии больных доставляют в ближайшие ОРИТ или ПИТ. Все больные, не имеющие тяжелых сопутствующих метаболических заболеваний (сахарный диабет) и иных острых состояний, должны получать питание согласно 15 диетическому столу. Больные без сознания и находящиеся на ИВЛ должны получать соответствующее парентеральное питание. В схему лечения больных коронавирусной инфекцией должна быть включена поддерживающая патогенетическая терапия, и проводиться профилактика осложнений и неблагоприятных исходов. Для предотвращения распространения заболевания должен соблюдаться жесткий контроль за соблюдением санэпидрежима.
Ключевые слова: Covid-19, клиническое ведение, лечение больных, инфекция.
If Covid-19 is suspected, patients are required to be hospitalized in an infectious diseases hospital in compliance with all preventive measures.
Hospitalizations are subject to:
1. Persons with fever and pneumonia or ARDS (based on clinical or radiological data) who visited the countries of the Arabian Peninsula 14 days before the onset of the first symptoms of the disease, or who had close contact with the patient who visited the Arabian Peninsula.
2. Persons with a fever and symptoms of a respiratory illness, provided they were in a medical facility (as a patient, employee or visitor) where epidemiologically related cases of coronavirus infection have been identified.
Treatment of patients with mild to moderate forms of the disease is carried out according to the treatment regimen for patients with influenza. Hospitalized patients with coronavirus infection should be placed in boxes or single rooms. If necessary, intensive care of patients is delivered to the nearest ICU or ICU. All patients who do not have severe concomitant metabolic diseases (diabetes mellitus) and other acute conditions should receive food according to the 15th dietary table. Patients unconscious and on mechanical ventilation should receive appropriate parenteral nutrition. Supportive pathogenetic therapy should be included in the treatment regimen for patients with coronavirus infection, and complications and adverse outcomes should be prevented. To prevent the spread of the disease, strict monitoring of compliance with the sanitary and epidemiological regime must be observed.
Treatment of patients with coronavirus infection:
1. Antiviral therapy.
Etiotropic drugs should be prescribed as early as possible (in the first hours or days of illness). As a broad-spectrum antiviral drug, Ribavirin can be recommended as a drug that has been successfully used in the treatment of SARS infections in China, Singapore and other countries. The dosage of the drug depends on creatinine clearance: with creatinine clearance> 60 ml / min - 400 mg iv every 8 hours for 3 days, then 1200 mg orally twice a day for another 7 days; with creatinine clearance of 30-60 ml / min - 300 mg iv every 12 hours for 3 days, then 600 mg orally twice a day for another 7 days; with creatinine clearance <30 ml / min - 300 mg iv every 24 hours for 3 days, then orally 600 mg once a day;
In the absence of signs of respiratory failure and symptoms of developing laryngospasm, an inhalation solution of Ribavirin can be used. In experimental studies on the model of macacresus infected with coronavirus infection, the effectiveness of the combination of Ribavirin and Interferon-α2b (IFN-α2b) was shown, which allowed the authors to conclude that this method of treatment of coronavirus infection is promising. Combination therapy with these two drugs has been used to treat patients with coronavirus infection. Ribavirin was used in doses up to 2000 mg per day (400-600 mg every 8 hours) in combination with the introduction of IFN-α2b at a dose of 100 μg 2 times a day subcutaneously. However, ribavirin therapy in combination with IFNα2b was started in the late stages of the disease (on average, on day 19 from the onset of the disease), when all 5 patients were already in extremely serious condition with severe respiratory failure. Despite the lack of effect from therapy, the authors suggest that timely treatment in the early stages of the disease can lead to positive therapeutic results. In 2004, in the cell culture and on the model of Syrian hamsters, data were obtained on the activity of the drug Arbidol (Umifenovir) in relation to coronavirus - the causative agent of SARS. Since the new coronavirus has an affinity for the coronavirus that caused the outbreak of SARS, the results allow Umifenovir to be considered as a potential tool for the prevention and treatment of human Covid-19 infections. The drug is recommended to be used 4 times a day, 200 mg every 6 hours (daily dose of 800 mg). In the early stages of the disease, neurominidase inhibitors (oseltamivir) and interferon inducers (meglumine acridone acetate, tilorone) can be used. The products of lung elastin proteolysis are the inducers of the terminal stages of the “cytokine storm”. In this regard, it is advisable to use proteolysis / protease inhibitors: - Aprotinin (Aerus) - 1 inhalation dose (1 dose of 85 KIU) in each nasal passage every 2–4 hours (800–2000 25 KIU / day). The maximum daily dose is 50–65 KIU / day / kg. The basic recommended inhalation course: - for viral inflammation in the nasal cavity - inhalation through the nose, exhalation through the mouth; - in the presence of symptoms of viral inflammation in the oropharynx, trachea and bronchi, inhale through the mouth and exhale into the nose; Combined inhalation of 1 dose into the nasal passages and through the mouth is possible; Course duration - from 3 to 8; - Aprotinin (Kontrikal) - in / in (slowly), jet or drip of 10000-20000 ATPE (contents of 1-2 ampoules) per day for 5-7 days; - Aprotinin (Gordoks) - in / in (slowly), in a jet or drip of 100,000 units 2-3 times a day for 5-7 days; - Aminomethylbenzoic acid (Amben) - in / in, jet 50-100 mg (5-10 ml of 1% solution) per day for 3-5 days (maximum single dose - 100 mg); To enhance the antiviral effect, the use of antioxidant therapy is indicated, which can also perform a cytoprotective function. The appointment of flavonoids and vitamins is recommended: - Rutoside (Rutin, Ascorutin) - 1-2 tablets 3-4 times a day; - Dihydroquercetin (Dihydroquercetin tablets, Diquvertin, Dihydroquercetin NTG, Araglin D); - Vitamin E - 100-300 mg / day; - Vitamin C - 50-100 mg 3-5 times a day after meals. Research is currently underway to find potentially effective drugs for coronavirus infection. In this regard, the antiviral 26 effect of a number of already known drugs used in other diseases. Lauren Stockman, Richard Bellamy and Paul Garner back in 2006 in animal experiments confirmed the effectiveness of Nitazoxanide against SARS. Consequently, this drug, which has proven itself well with rotavirus infection, can also be used in cases of suspected coronavirus infection.
2. Antibacterial therapy for patients with coronavirus infection should be prescribed the same treatment as any patient with pneumonia of unknown etiology. It is recommended to include antibacterial drugs with a wide spectrum of activity (levofloxacin, ceftriaxone) in the regimen for guaranteed suppression of known bacterial agents. In addition, the use of antibacterial drugs prescribed by current standards for the treatment of community-acquired pneumonia is recommended.
3. Anti-inflammatory and antipyretic therapy.
From the group of non-steroidal anti-inflammatory drugs, it is recommended to prescribe dosage forms that have both a pronounced antipyretic and a pronounced anti-inflammatory effect. Anti-inflammatory therapy should be started in combination with etiotropic therapy from the first days of the disease. Indications for the use of additional antipyretic drugs are the absolute numbers of 27 thermometry (above 38–38.5 C), pronounced brain and cardiovascular disorders. ,
4. Detoxification therapy: - Electrolyte solutions - Glucose solution (5% and 40%) in combination with ascorbic acid and panangin; - Albumin - 10-20% solution at the rate of 5-10 / 2-5 mg / kg iv / drop (it is advisable to prescribe to patients with hypoalbuminemia); - Meglumina sodium succinate - Reamberin (Sodium chloride + Potassium chloride + Magnesium chloride + Sodium hydroxide + Meglumina sodium succinate) - in / drip at a rate of up to 90 drops / min (1-4.5 ml / min) - 400-800 ml / day; - Cytoflavin (Inosine + Nicotinamide + Riboflavin + Succinic acid) - in / in a drop of 5.0-10.0 ml in dilution per 100-200 ml of a 5-10% dextrose solution or 0.9% sodium chloride solution; - Remaxol (succinic acid + Nicotinamide + Inosine + methionine + N-methylglucamine) - iv, drip at a rate of 40-60 drops / min (2-3 ml / min) - 400-800 ml / day; The total volume of infusion therapy can be up to 1.5 liters per day. Infusion therapy is carried out under the mandatory control of the patient's condition, including blood pressure, auscultatory picture of the lungs, hematocrit (not lower than 0.35 l / l) and diuresis. Caution should be taken when administering intravenous solutions to patients with SARI, as excessive transfusion of fluids can impair blood oxygen saturation, especially in conditions of limited mechanical ventilation. In order to prevent cerebral edema and pulmonary edema in patients with coronavirus infection, it is advisable to carry out infusion therapy against the background of forced diuresis (lasix / furosemide 2-4 ml - 1% w / m). The appointment of infusion therapy to patients with severe / complicated forms of coronavirus infection can pursue various therapeutic goals: detoxification, dehydration, control of protein, water-electrolyte and acid-base balance.
5. Respiratory support
Treatment of patients with severe / complicated form of coronavirus infection should include, along with antiviral and pathogenetic therapy. Description of the method: oxygen is inhaled through a mask or nasal catheter at a rate of 5-7 liters per minute, if necessary increasing to 10 liters per minute. Before the appointment of inhalation, SpO2 is determined and, after 10-15 minutes, the measurement is repeated. A positive therapeutic effect is manifested in an increase in SpO2 by 2% or more (PaO2 more than 60 mmHg, SpO2 above 92%).
LITERATURE:
2. https://pro.ispringcloud.ru/acc/5LCYqyQzNzIz/s/3723-VW6Fv-gZWcN-r6XJN
3. Risk assessment: Outbreak of acute respiratory syndrome associated with a novel coronavirus, China: first local transmission in the EU/EEA − third update. — European Centre for Disease Prevention and Control (ECDC), 2020.
4. Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adult with Coronavirus Diasease 2019.
5. Zhou, Peng. Discovery of a novel coronavirus associated with the recent pneumonia outbreak in humans and its potential bat origin.
© Kosykh A.V., 2020
Предварительный просмотр:
УДК 378.178
Features of adaptation of 1st year students to study at a university
Kosykh Alexander Vyacheslavovich
Teacher, pharmacist-organizer,
clinical pharmacologist
FSBEI of HE «Stavropol State Medical University»Essentuksky branch
(Russia, Essentuki)
Email: alekskosyx@mail.ru
The article studies the features of adaptation of 1st year students to study at a university. One of the most important pedagogical tasks of any university is to work with first-year students, aimed at their faster and more successful adaptation to the new system of education, to the new system of social relations, to mastering the new role of students.The task of the university in this difficult period is to help it adapt to new learning conditions as quickly and successfully as possible, to join the ranks of the student body.
Key words: adaptation, personality, stress
Особенности адаптации студентов 1 курса к обучению в вузе
Косых Александр Вячеславович
Преподаватель, провизор-организатор,
клинический фармаколог
ФГБОУ ВО «Ставропольский государственный медицинский университет» Ессентукский филиал
(Россия, Ессентуки)
Электронная почта: alekskosyx@mail.ru
В статье изучаются особенности адаптации студентов 1 курса к обучению в вузе.Одной из важнейших педагогических задач любого вуза является работа со студентами первого курса, направленная на более быструю и успешную их адаптацию к новой системе обучения, к новой системе социальных отношений, на освоение ими новой роли студентов.
Задача вуза в этот сложный период состоит в том, чтобы помочь ему как можно быстрее и успешнее адаптироваться к новым условиям обучения, влиться в ряды студенчества.
Ключевые слова: адаптация,личность,стресс
One of the most important pedagogical tasks of any university is to work with first-year students, aimed at their faster and more successful adaptation to the new system of education, to the new system of social relations, to mastering the new role of students.
The task of the university in this difficult period is to help it adapt to new learning conditions as quickly and successfully as possible, to join the ranks of the student body.
The problem of adaptation is relevant for all levels of education. Despite the existing differences in the target, content and procedural components, at each educational level, the adaptation process is characterized by the presence of both specific and general.
The need for adaptation in a person arises when he begins to interact with a system under conditions of a certain mismatch with it, which gives rise to the need for changes. These changes can be associated with the person himself or the system with which he interacts, as well as the nature of the interaction between them. That is, the starting mechanism of the human adaptation process is a change in his environment, in which his usual behavior turns out to be ineffective or generally ineffective, which gives rise to the need to overcome difficulties associated precisely with the novelty of conditions.
There are many definitions of the phenomenon of adaptation. In a generalized form, adaptation is described as an adaptation necessary for an adequate existence in changing conditions, and also as a process of including an individual in a new social environment, mastering the specifics of new conditions. Most researchers see the specificity of human adaptation in his ability to actively and consciously influence the environment. In comparison with various animal species, the adaptive capabilities of a person who has not only a biological, but also a developed social base are determined by the widest range of "flexible links". Social adaptation is the process of integrating an individual into a social group, which implies acceptance of group norms, values, standards, stereotypes and requirements.
In modern sociology and psychology, the concept of adaptation is considered as a process and result of establishing harmonious relationships between the individual and the social environment. According to Zh. G. Senokosov, “the essence of adaptation is bringing the subject of adaptation into optimal compliance with the requirements of the environment, i.e. object of adaptation. When stability is disturbed (the subject moves to another environment, other conditions, or when the environment itself changes), there is a mismatch in the interaction of the subject and the object in the system, which leads to functional disorder, loss of integrity. As a result, an adaptive situation arises when the system or its individual elements strive to restore the disturbed equilibrium. Such situation characteristic of all types of human adaptation, understood as an active, purposeful process of resolving the contradictions that arise during his interaction with the new natural and social environment. "
V. A. Yakunin understands adaptation as the process of interaction between a person and the environment, as a result of which he has models and strategies of behavior that are adequate to the conditions changing in this environment. The author considers it possible to apply this general definition to the conditions of the educational environment.
In the process of adaptation, the personality adapts to changes in the social environment by selecting or restructuring behavior strategies. So, for example, the criterion of optimal compliance of a personality with the conditions of a changing social environment was used by D.V. Kolesov to build a model of the stages of the adaptation process, which contains the following stages.
Balancing - establishing a balance between the environment and the individual with the manifestation of mutual tolerance to the system of values and stereotypes of behavior.
Pseudo-adaptation is a combination of external adaptation to the situation with a negative attitude towards its norms and requirements.
Adaptation is the recognition and acceptance of the core values of the new environment.
Assimilation is a mental reorientation of an individual, a transformation of previous views, orientations, attitudes.
E.V. Osipchukova singles out the following stages in the adaptation of the personality of the first-year student and, accordingly, the study group to which he belongs to the new socio-cultural environment of the university:
1.the initial stage, when an individual or a group realizes how they should behave in a new social environment for them, but are not yet ready to recognize and accept the value system of the new university environment and strive to adhere to the old value system;
2. the stage of tolerance, when the individual, the group and the new environment show mutual tolerance for the value systems and patterns of behavior of each other;
3. accommodation, i.e. recognition and acceptance by the individual of the main elements of the value system of the new environment, while recognizing some of the values of the individual, the group as a new socio-cultural environment;
4.assimilation, i.e. complete coincidence of the value systems of the individual, group and environment.
As a result of the realization of personal adaptive potential in the process of adaptation, a certain state of personality is achieved - adaptability, as a result, the result of the adaptation process.
Achieving a certain level of adaptability depends on what strategies of adaptive behavior a person chooses in a situation of interaction with the environment and how these strategies are combined with each other.
N.N. Melnikova calls the following strategies of adaptive behavior:
1. active change in the environment;
2. active change of oneself;
3. leaving the environment and looking for a new one;
4. withdrawal from contact with the environment and immersion in the inner world;
5. passive self-representation;
6. passive submission to environmental conditions;
7. passive waiting for external changes;
8. passive expectation of internal changes.
There are studies showing that the greatest adaptive effect, reflecting a high level of adaptation, is provided by a combination of strategies aimed at actively and simultaneously changing oneself and the environment. The external adaptation of the learning subject to the educational environment, which does not cause intrapersonal changes, as well as two alternative models of behavior: leaving the environment or waiting for external and intrapersonal changes, leads to a moderate adaptation result. A low level of adaptation, associated with a pronounced negative effect in adaptation, manifests itself in the subject's refusal to interact with the external environment and in immersion in his inner world.
Researchers state the presence of a multifactorial determinism of the adaptation process and the fact that at different stages of learning it is determined by the structural rearrangement of the psychological factors that determine it.
Each teacher of a higher educational institution knows from his own experience that working with first-year students, pedagogical communication with freshmen has its own distinctive features. This is due to both psychophysiological characteristics of age and social factors.
There are three blocks of factors influencing the adaptation to education at the university: sociological, psychological and pedagogical.
Sociological factors include the age of the student, his social background and the type of educational institution he has already graduated from. The psychological block contains individual psychological, social and psychological factors: intelligence, orientation, personal adaptive potential, position in the group. The pedagogical block of factors influencing adaptation includes the level of pedagogical skill, organization of the environment, material and technical base, TSO, etc.
Any education, especially university education, is not an easy task. This is due to numerous organizational, methodological and psychological reasons. There are both general difficulties, typical for all students, and particular ones, characteristic only for junior students, for example, stressful conditions that arise in school graduates in connection with the transition to another form of activity.
School graduates from the first days plunge into a completely different, unfamiliar life. And in order to resolve the issue of successful adaptation of yesterday's schoolchildren in the new conditions, it is necessary to identify the most typical problems with which most students face in the first year of their studies.
According to the results of a study aimed at identifying the main difficulties faced by first-year students can be named. the following are the most significant problems of the first months of training:
• noticeably increased volume of teaching load;
• the complexity of mastering new academic disciplines;
• difficulties in relationships with fellow students;
• building a new system of relations with teachers.
The data obtained were used to determine the main activities of the curators of academic groups, to develop a system of organizational, scientific and methodological support for educational and extra-curricular work with junior students.
At the same time, according to the results of the same study, only 30% of all surveyed freshmen categorically deny the need for psychological assistance. Another 30% of students found it difficult to answer. The remaining 40% of freshmen believe that they need psychological help first of all when solving the following problems:
• overcoming stress before the first session;
• joining a new team;
• rallying the study group;
• solving personal problems.
One of the most important social factors influencing the behavior of a first-year student, his relationship with other students and university teachers is the change in the social situation, the need to get used to new learning conditions, the development of a new social role - a student of a higher educational institution.
Recognizing the multifactorial determinism of students' adaptation to the educational and educational environment of the university, it is necessary to note the role of pedagogical management of this process. One of their effective forms of such management is the activity of the institution of curators of student groups.
Ensuring effective adaptation of first year students to the new educational and educational environment was the goal that determined the content of the corresponding pedagogical tasks. Work in this direction made it possible to single out a system of consistent and interrelated steps:
• study of personal characteristics of freshmen;
• identification of the difficulties of the adaptation period and the peculiarities of the "entry" of students into student life;
• analysis and generalization of the obtained data;
• preparation, based on research data, of recommendations for curators and teachers working with first-year students, aimed at optimizing the adaptation period;
• holding a round table with the participation of the vice-rector for social and extracurricular activities, deputy. deans for educational work, specialists of the management of organizational and educational work on the problem of adaptation of freshmen;
• inclusion of a curatorial hour in the curriculum of first-year students, within the framework of which various-scale events are held in various thematic programs;
• development and continuous improvement of thematic educational programs for first-year students;
• organizing and conducting a series of practical classes with student assets and first year elders aimed at increasing the level of awareness of the difficulties of the adaptation period, mastering ways to overcome them and developing constructive communication skills;
• development of a cycle of practical classes for first-year student groups, which will be further recommended for holding within the framework of the curatorial hour;
• approbation of these lessons by OWRM specialists in real study groups of freshmen and making necessary adjustments;
• organizing and conducting the School of Curators and Young Teachers working with first-year students, aimed at increasing the level of psychological and pedagogical literacy among teachers;
• organizing and conducting methodological seminars with the curators of the first courses to master the methodology of conducting practical classes in student groups within the framework of the curatorial hour;
• socio-psychological and scientific-methodological support of the activities of the curators in the process of mastering the proposed methodology for conducting group lessons with freshmen;
• individual and group counseling for students and teachers;
• joint summing up, analysis of the results of the work done and planning of work for the future.
Thus, in solving pedagogical problems associated with increasing the effectiveness of adaptation of first-year students to study at the university, the most important role is assigned to the curators of academic groups.
All participants in the educational process are interested in effective adaptation to the university: not only the first-year students themselves, but also the teachers and staff working with them, the leadership of faculties and the university. teachers and group mates, to attract the attention of organizers of scientific student societies and leaders of various creative teams and student associations, activists of faculty and university social life.
The further professional career and personal development of the future specialist largely depend on the success of the student's adaptation to the educational environment of the university.
LITERATURE:
1. Anfinogenova OI Features of adaptation of first-year students to the learning environment at the university // New research. - 2017. -T. 1. - No. 26. - S. 55-59.
2. Bernler G., Yunsson L. Theory of social and psychological work, trans. from the Swede. - M., 1992.
3. Gingel E. Dialogue as a factor of adaptation of freshmen // Higher education in Russia. -2017. - No. 9. - S. 158-160.
4. Zaripov R. N., Zaripova I. R. Adaptation of students in a technological university: psychological and pedagogical aspect // Bulletin of the Kazan Technological University. - 2016. - No. 24. -P. 236-242.
5. Kolesov DV Adaptation of the body of adolescents to training loads. - M., 2017 .-- 176 p.
© Kosykh A.V., 2020