COVID-19 IN DIABETES PATIENTS IN UKRAINE: LESSONS FOR DOCTORS AND PATIENTS.

World Health Organization recognized coronavirus disease 2019 (COVID-19) as a pandemic on 11 March 2020. The first case of COVID-19 in Ukraine was confirmed on 3 March 2020 in Chernivtsi and the first lethal case was reported on 13 March 2020. As of 22 April 2020 6592 cases of COVID-19 have been reported in Ukraine, among these cases 174 caused death (2.64% lethality), 467 patients (7.08% of cases) have recovered. The feature of COVID-19 pandemics in Ukraine is that the age of patients is lower (50-59 years old, 40-49 years old and 30-39 years old) than in China and other European countries. Another feature of COVID-19 epidemiology in Ukraine is that virus cause disease in women (56.0%) more often than in men (44.0%). But there are more male patients in other countries. Although there are more male deaths (51.7%) than female (48.3%) in Ukraine. Deaths have occurred in 30-49 years old patients (14%), in 50-69 years old patients (48%), in 70 years old and older patients (38%). 85% of all deaths were over 50 years of age. 79% of patients who died from COVID-19 had severe cardiovascular diseases, diabetes mellitus, neoplasms, renal diseases, respiratory disorders and obesity. In total, co-morbidities (one or several) have been cardiovascular diseases (74%), diabetes mellitus (22%), lungs diseases (9%), neoplasms (8%), renal diseases (7%). In this article we analyzed epidemiology and causes of negative influence of diabetes mellitus on COVID-19 progress in world and Ukraine. We also made recommendations on prophylaxis and patients treatment in cases of COVID-19 and diabetes mellitus co-morbidity.

THE MAIN CAUSES OF THE COMPLICATED COURSE OF COVID-19 IN PATIENTS WITH DIABETES MELLITUS AND TREATMENT (REVIEW).

Among the main risk factors for the development of a severe course of Coronavirus disease 2019 (COVID-19) are old age, arterial hypertension, diabetes mellitus (DM), chronic obstructive pulmonary diseases, cardiovascular and cerebrovascular diseases. The aim of this study was determinating the main causes of complicated COVID-19 course in diabetic patients. Publications were searched using PubMed and Google Scholar for keywords: COVID-19, diabetes, hyperglycemia, carbohydrate metabolism disorders, and complications. The review of scientific literature considers the main causes and pathogenetic mechanisms of COVID-19 complications development in patients with DM. Groups of factors that worsen the disease course were identified. We also proved that modern treatment of COVID-19 in diabetic patients should consider all risk factors and include a multidisciplinary team approach with specialists in emergency medicine, endocrinology, infectious diseases, respiratory support, nutrition and rehabilitation. The main reasons that worsen the course of COVID-19 in patients with DM are features of DM and mutual influence of DM and COVID-19; the influence of separate medicines groups used in the treatment of both diseases; shortcomings in the organization of patients' treatment and care. The main factor that is crucial in the management of these patients is the normalization of blood sugar level and carbohydrates metabolism achieved by all possible means.

[OPIATES IN THE COMPLEX OF ANALGESIA AFTER THORACOTOMY AND ANALYSIS OF THE COMPLICATIONS].

The goal: to study the influence of various methods of analgesia on the state of postoperative anesthesia in patients after thoracotomy; compare the quantity of narcotic analgesics (morphine) used in different types of anesthesia and anesthesia related complications. In 85 patients after thoracotomy, anesthesia was performed by prolonged paravertebral analgesia (PVA) (19 patients), by prolonged epidural analgesia (EDA) (36 patients) with 0.2% solution of rapamycain and by an intravenous patient-controlled analgesia (PCA) with a morphine solution in the control group (30 patients). In all three groups, the nonsteroidal anti-inflammatory drug (NSAIDs) ketorolac tromethamine was used intramuscularly. The evaluation was performed within 3 days after surgery using the visual analog scale (VAS). In the PVA group, the pain level was 29.1 points four hours after surgery to 18.7 points at the end of the third day; in the EDA group - from 24.2 to 20.3 points, respectively; in the control group - from 48.8 to 38.0 points, respectively. The need for morphine administration within the first day after surgery was the highest in the control group and was 42.83±13.23 mg/day. In experimental groups, the need for morphine was 15.0±5.0 mg/day in the EDA group and 16.15±5.38 mg/day in the PVA group. The greatest number of complications was observed in the control group and was associated with the use of morphine. The method of anesthesia associated with the use of PVA was accompanied by the least amount of complications. In terms of the effectiveness of analgesia and the amount of narcotic analgesic used, it was comparable to EDA. Patients of this group least often developed chronic postoperative pain syndrome. PVA may be a priority for postoperative pain management in patients after thoracotomy.

[Application of tivortin in complex treatment of diabetic foot syndrome].

Theoretical pre-conditions and practical possibilities of preparation Tivortin application in a complex of surgical treatment of diabetic foot syndrome were studied up. Basing on the result of the investigation performed it was established, that while this preparation application a postoperative period course improves, the carbohydrates metabolism normalizes, the pain syndrome intensity reduces.