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При переходе к биологической терапии необходимо рассмотреть возможность подкожного введения, чтобы ограничить контакт пациента с медицинским учреждением. Выборочный переход от внутривенных инфузий инфликсимаба к препаратам анти-TNF с подкожным введением не рекомендуется, поскольку это может увеличить риск рецидива. Если пациент находится в контакте с человеком COVID-19, необходимо рассмотреть возможность отказа от терапии анти-TNF в течение 2 недель. Если у пациента положительный результат теста на SARS-CoV-2 и/или у него развивается COVID-19, необходимо рассмотреть возможность отказа от биопрепаратов до тех пор пока пациент не избавится от инфекции.
The use of thiopurine (azathioprine and mercaptopurine) reduces the immune response to viruses, which is associated with an increased risk of opportunistic infections. There is limited evidence that they increase the risk of respiratory infections. The risks and benefits should be considered, but most patients can continue on a stable dose. In patients in stable remission, elderly patients and in the presence of concomitant pathology, it is recommended to stop taking thiopurine. During a pandemic, it is recommended to avoid starting thiopurine or increasing the dose, which will allow patients to avoid potential side effects. If the patient is in contact with a COVID-19 person, temporary withdrawal of thiopurine for 2 weeks should be considered. If a patient tests positive for SARS-CoV-2 and/or develops COVID-19, temporary discontinuation of thiopurine may be recommended until the patient clears the infection.
So, at the population level, health is a multifactorial phenomenon that includes both an objective and a subjective component. Considering that low self-esteem of health is a factor influencing its formation in young people, their choice of risky behavior, propensity for bad habits and psychological disorders, it is important to take into account the subjective component of health in adolescents and young people. the purpose of early detection of certain deviations in self-esteem or the impact on the formation of health of adverse factors, the effect of which can be minimized.
Moreover, low vitamin D levels common in patients with CVD may increase the risk and severity of COVID-19. This is because vitamin D increases levels of anti-inflammatory cytokines and reduces viral replication, which in turn can reduce pro-inflammatory cytokines that contribute to lung damage. Despite the lack of evidence demonstrating increased susceptibility to COVID-19, drugs used in the treatment of COPD increase the risk of respiratory tract infections to varying degrees. However, theoretically, some immunosuppressive drugs may have beneficial effects, given that the cause of death in COVID-19 is a cytokine storm leading to acute respiratory failure.
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