Методические рекомендации посвящены вопросам практической работы по диагностике и лечению новой коронавирусной инфекции COVID-19. Целью создания данного документа явилась необходимость выработки единого подхода в организации помощи пациентам с новой коронавирусной инфекцией COVID-19 в военных стационарах с позиций практического опыта специалистов госпиталя, требо-ваний национальных рекомендаций. наиболее важные рекомендации касаются вопросов правильного понимания заболевания, алго-ритмов действий врачебного персонала и режимов фармакотерапии пациентов с коронавирусной инфекцией. Ключевые слова: новая коронавирусная инфекция COVID-19, фармакотерапия, алгоритмы работы, клинические рекомендации. Для цитирования: Зайцев А.А., чернов С.А., Стец В.В. и др. Алгоритмы ведения пациентов с новой коронавирусной инфекцией COVID-19 в стационаре. Методические рекомендации. Consilium Medicum. 2020; 22 (11): 91–97. DOI: 10.26442/20751753.2020.11.200520

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The guidelines are devoted to the practical application of the method of remote physical rehabilitation of patients with the new coronavirus infection COVID-19 through telecommunication technologies. The purpose of the document is the need to develop a unified approach in organizing assistance for physical rehabilitation for patients with the new coronavirus infection COVID-19 in military hospitals. The advantage of using telecommunication technologies is associated with a decrease in the risk of personnel infection.

Use of antithrombotic aids (ATA)  significantly  impact  the prevention of life-threatening cardiovascular complications. ATA applications, however, are associated with a wide range of adverse digestive system responses. Due to, continuously growing clinical use of ATA this problem has become a current challenge of contemporary medicine.Purpose of the study was to evaluate the patterns of digestive system damage in patients receiving ATA.Materials and Methods. 672 patients were examined, 91.0% males, 46.7±17.4 years of age, who had digestive system changes that  occurred  due to ATA intake. 71 patients were admitted for treatment after gastrointestinal (GI) bleeding; other  patients were hospitalized  because of disorders  of the digestive  system or erosive and ulcerous changes of the digestive  system detected by endoscopy.  The following parameters were  evaluated:  GI bleeding sources, character of complaints,  the endoscopic patterns due to intake of different ATAs (low doses of aspirin, warfarin, clopidogrel,  dabigatran, rivaroxaban, low-molecular  heparin,  combined  therapy), and of risk factors for GI complications.Results. The sources of GI bleeding (n=71) included  gastric ulcers and/or erosions (39.4%), duodenum ulcers and/or erosions (21.1%), colon ulcers and/or erosions (28.2%), unknown  (11.3%). The majority of 672 patients noticed  various  complaints:  sensation  of heaviness  in epigastrium (62.8%),  gastralgia  (46.7%),  burning  sensation (34.3%). Endoscopy found erosive esophagitis (13.2%), ulcers in stomach and/or duodenum (11.6%), multiple (  10) erosions of stomach or duodenum (17.1%), sporadic erosions of stomach or duodenum (24.4%). In 32.3% cases no erosive or ulcerous alterations were found. H. pylori was identified in 57.9% of patients. There was no significant difference in character of alterations in the upper digestive system between patients who received different ATA treatment, except of frequent erosive esophagitis in those patients who received dabigatran (16.8%). The elderly age (  65 years), ulcer history, concomitant intake of NSAIDS, H. pylori presence, and smoking habit were associated with a higher occurrence of pathological alterations of digestive system. Presence  of gastralgia  did not correlate with the development of erosive and ulcerous alterations.Conclusion. In majority of patients who received ATA, the commonly observed erosive and ulcerous alterations in the digestive system might become a source of bleeding.

This article discusses the main aspects of the nebulizer therapy used to treat respiratory diseases. The basic principle of operation of all types of nebulizers is based on the generation of aerosol containing particles comprising an active substance. Currently, there are three types of nebulizers: jet, or compressor (which uses the energy of a gas jet), ultrasonic (which uses oscillation energy of the piezoelectric element) and membrane (Mesh nebulizers). The jet nebulizers are the most common, because they have affordable cost, are easy to use, however, using this type of nebulizers is accompanied by quite large losses of the drug (more than 50%), and they are quite noisy due to the compressor. Among the advantages of ultrasonic nebulizers are virtually silent operation, fast aerosol production and shorter inhalation times compared to compressor devices, small size and weight, and operation from the batteries. However, one of the most important disadvantages of ultrasonic nebulizers is the limited range of drugs that can be used for inhalation, which significantly limits their use in pulmonological practice. In particular, they are not suitable for inhalation of suspensions (glucocorticosteroids) due to the impossibility of homogeneous nebulization, in addition, part of the GCS molecules are destroyed by ultrasound. In recent years, the greatest prospects have been associated with the use of a new generation of nebulizers created using the so-called Vibrating Mesh Technology. Membrane nebulizers have a number of advantages compared to the compressor and ultrasonic devices. Among them are a small residual volume, noiseless operation, high mobility due to the small size, weight and ability to operate using battery.