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Пульс - медицинский центр
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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.
Responding to such epidemic challenges is very difficult both organizationally and financially. The result is evaluated over time with well-organized epidemiological surveillance. According to the approved polio outbreak response plan, which arose in early October 2021, it was only possible to start the 1st round of the campaign on February 1, 2022. It was supposed to last 3 weeks and was aimed at vaccinating 140,000 children from 6 months of age with IPV. up to 6 years who missed vaccination according to the Calendar. Almost by the end of the 3rd week of the 1st round, as of February 18, 2022, only 28% of the planned number of children were vaccinated. Therefore, we decided to extend the 1st round for an additional 2 weeks, which again was not performed due to the outbreak of war. Thus, there was no actual response to polio outbreaks.
When transitioning to biological therapy, subcutaneous administration should be considered to limit patient contact with the healthcare facility. Selective switching from intravenous infliximab to subcutaneous anti-TNF is not recommended as it may increase the risk of relapse. If the patient is in contact with a COVID-19 person, withdrawal of anti-TNF therapy for 2 weeks should be considered.
Отдельной проблемой является лечение АГ у больных COVID-19. Наличие в анамнезе АГ у пациентов с COVID-19 ассоциировалось с более тяжелым течением инфекции в отличие от больных, у которых гипертензия отсутствовала. По современным представлениям в период пандемии COVID-19 больные АГ должны тщательнее следить за уровнем своего АД и принимать постоянно рекомендованные врачом препараты. Это касается и применения для лечения больных АГ так называемых блокаторов ренин-ангиотензиновой системы: ингибиторов ангиотензин-превращающего фермента и блокаторов рецепторов ангиотензина II. Целый ряд проведенных в последнее время исследований, что указанные группы препаратов не только не повышают риск инфицирования вирусом, но и достоверно улучшают течение коронавирусной болезни.
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