The use of an Inhaled Surfactant in Patients With Severe and Extremely Severe new Coronavirus Infection COVID-19 With Concomitant Cardiovascular Pathology.

Aim      To study the effectiveness of nebulized surfactant therapy as a part of a multimodality treatment of severe and extremely severe COVID-19 viral pneumonia with concomitant cardiovascular diseases (CVDs).Material and methods  This retrospective controlled study analyzed a multimodality treatment of 38 patients with severe and extremely severe COVID-19 viral pneumonia and concomitant CVDs who were administered nebulized surfactant for correction of acute respiratory distress syndrome (ARDS). The control group consisted of 105 patients with severe and extremely severe novel coronavirus infection with concomitant CVDs who were not administered surfactant as a part of the multimodality therapy.Results Administration of nebulized surfactant as a part of the multimodality treatment in patients with COVID-19 allowed alleviating the severity of respiratory insufficiency (р<0.001), which decreased the death rate of patients with severe and extremely severe COVID-19 and undoubtedly demonstrated the effectiveness of this medicine. The timely multimodality therapy, including nebulized surfactant, improves the course of the disease. Thus, the absence of a possibility for administering nebulized surfactant for more than 4 days was associated with fatal outcomes (р=0.045).Conclusion      Administration of nebulized surfactant as a part of the multimodality treatment of severe and extremely severe COVID-19 and concomitant CVDs increases the survival (р<0.001) and reduces the mortality by 46 %. The risk factors of an unfavorable outcome of this disease include an age older than 65 (р=0.020), a positive polymerase chain reaction test (р=0.037), a ferritin concentration at baseline >600 mg /ml (р<0.001), and a surfactant treatment duration < 4 days (р=0.045). Further study of the efficacy of nebulized surfactants as a part of the multimodality therapy is required and should include randomized clinical trials with a large number of patients and the development of distinct criteria for the treatment of ARDS.

[Morphological signs of inflammatory activity in different clinical forms of drug-resistant pulmonary tuberculosis]. / Morfologicheskie priznaki aktivnosti vospaleniia pri razlichnykh klinicheskikh formakh lekarstvenno-ustoichivogo tuberkuleza.

AIM: to determine whether the activity of tuberculous inflammation is associated with different clinical forms of drug-resistant pulmonary tuberculosis. SUBJECTS AND METHODS: The material taken from 310 patients operated on in 2010-2015 were retrospectively examined. The patients underwent economical lung resections of limited extent (typical and atypical ones of up to 3 segments) for circumscribed forms of tuberculosis with bacterial excretion. A study group consisted of 161 (51.9%) patients with drug-resistant variants of pulmonary tuberculosis. A control group included 149 (48.1%) patients with preserved susceptibility of Mycobacterium tuberculosis to anti-TB drugs. The activity of specific changes in tuberculosis was morphologically evaluated in accordance with the classification proposed by B.M. Ariel in 1998. RESULTS: The highest activity of fourth-to-fifth degree specific inflammation, including that outside the primary involvement focus, was obtained in the drug-resistant pulmonary tuberculosis group due to the predominance of patients with cavernous and fibrous-cavernous tuberculosis versus those in whom the susceptibility to chemotherapeutic agents was preserved. A macroscopic study showed that the primary lesion focus had a median size in one-half of the all the examinees; but large tuberculomas, caverns, and fibrous caverns over 4 cm in diameter were multiple and detected in the drug-resistant pulmonary tuberculosis group. Multidrug resistance was observed in more than 60% of the patients with fibrous-cavernous pulmonary tuberculosis, extensive drug resistance was seen in those with cavernous tuberculosis, which is an aggravating factor. The data obtained from the morphological study of the intraoperative material can specify the clinical form of tuberculosis and evaluate the efficiency of preoperative specific therapy. The highest activity of specific inflammation was observed in patients with multiple drug-resistant pulmonary tuberculosis, the prevalence of third-to-fourth degree specific changes was seen in those with multiple and extensively drug-resistant tuberculosis. CONCLUSION: The findings suggest that the activity of tuberculous inflammation is associated with different clinical forms of drug-resistant tuberculosis and with a spectrum of drug resistance.