Lege Artis Medicinae - 2021;31(5-6)

Lege Artis Medicinae

JUNE 07, 2021

[Inflammation and autoimmunity in COVID-19]

SZEKANECZ Zoltán, SZAMOSI Szilvia, SZŰCS Gabriella

[The course of COVID-19 has several stages according to the elapsed time and severity. Cytokine storm-induced multisystemic inflammatory syndrome (MIS) and consequent multiorgan failure occur in severe and critical phases. From a pathological point of view, there is important the co-presenting of inflammation (endothelitis) and microthrombotic events. Beyond respiratory failure, they may harm the cardiovascular and nervous system, the liver and the kidneys. COVID-19 may be associated also with production of autoantibodies and development of autoimmune diseases. Multisystemic inflammatory syndrome can be attenuated by corticosteroids, anti-cytokine antibodies and JAK inhibitors (“repurposing”). Most IL-6 inhibitors, and barici­tinib proved to be effective in several stu­dies, when applied in appropriate stage by MIS identification.]

Lege Artis Medicinae

JUNE 07, 2021

[Practical aspects of anticoagulant treatment during the COVID-19 pandemic]

KOMÓCSI András

[Coronavirus infection has a multiple im­pact on the coagulation system and anti­coagulant therapies. Patients admitted with COVID-19 have un­usually high incidence of coagulation ab­normalities. The incidence of atrial fibrillation (AF) seems also to be more frequent among COVID-19 out- and especially in-patients. Among COVID-19 patients receiving oral anticoagulant therapy, for minimizing the risk of bleeding or thromboembolic complications there should also be considered the renal and hepatic functions and drug-drug interactions of oral anticoagulant and COVID-19 therapy. In case of direct anticoagulants, in addition to the benefits of better safety, more favorable treatment ad­he­rence, and fixed dosing, the use of this class of drugs does not require laboratory mo­nitoring of efficacy, which may be of exp­licit benefit in terms of social distancing and health network burdens. This study reviews the possible interactions of drugs used for viral infection and anticoagulation, and in addition to the issues of coagulopathy associated with COVID-19, we discuss also the concerning difficulties of continued anticoagulant therapy related to the social distancing measures.]

Lege Artis Medicinae

JUNE 07, 2021

[Lipid lowering therapy during COVID-19 pandemic]

MÁRK László

[The COVID-19 pandemic posed significant challenges to all healthcare systems of the world as created a new situations above the large number of people infected, solutions of which were lacking any previous patterns. Former experiences were specifically needed among physicians who practised usually with therapies supported by evidence based clinical experiences thus they were working along the principles of Evidence-Based Medicine. The new observations and recommendations for treating infected patients increased gradually, however they were not always well-founded by the general urgency. In this situation, physicians faced often problems of the patient’s former medications since they had to focus on the therapy of the prevalent life-threatening condition. In such cases, therapy as lipid lowering, which is inherently inimically and lightly taken, may be omitted even more often. Basic drugs of lipid lowering are statins. They are used to reduce cholesterol levels and the risk of cardiovascular events, but they have also been described as having beneficial effect on the new viral infection. In this effect, the statins beyond the well-known anti-inflammatory impact and increasing the expression of angiotensin-converting enzyme-2 further mechanisms can take part as well. These may include among others the promoted breakdown of lipid rafts, which directly inhibits the entry of coronavirus into the cell through the S protein by decreasing the level of cholesterol required for this proceeding. In a group of more than 1200 statin treated and SARS-COV-2 infected patients the overall mortality rate by the 28th day was 48% lower than among the non-statin-users. According to a meta-analysis of nearly nine thousand COVID-19-infected statin users, they had 30% lower mortality rate or serious complications. Up to date observational studies suggest that statin therapy and the administration of other lipid lowering drugs should be continued or initiated according to the guidelines also during the COVID-19 infection.]

Lege Artis Medicinae

JUNE 07, 2021

[Hypertension, COPD and COVID-19. Focus on antihypertensive therapy]

FARSANG Csaba

[Chronic obstructive pulmonary disease is a very common comorbidity of hypertension and it is often unrecognised by physicians. The factors involved in the pathomechanism of both diseases should be realised when choosing treatment. Among factors, hypoxia, increased tone of sympathetic nervous system and activation of renin-angiotensin-aldosterone system should primarily be considered. Vascular wall damage and endothelial dysfunction has an important role in both conditions. The goals of treatment are elimination of risk factors, optimizing the blood pressure, the consequential prevention of cardio-cerebrovascular, renal and pulmonary damage; finally prolonging the patients’ life and improving their quality of life as well. Both hypertension and COPD significantly worsen the condition of COVID-19 patients since they increase the severity of the disease and the rate of in-patients’ and their mortality. In the treatment of hypertension among COPD and COVID-19 patients there must be emphasized the medication inhibiting of renin-angiotensin-aldosterone system, such as angiotensin-converting en­zyme inhibitors or angiotensin-II AT1 re­cep­tor antagonists. Special attention concerned the beneficial effect of mineralocorticoid receptor antagonist spironolactone. Other antihypertensive drugs (calcium channel blockers, thiazide-like diu­retics, high selectivity β1 receptor antagonists) may supplement the treatment if necessary. Long-acting β2 receptor agonists, muscarinic receptor antagonists and inhalation corticosteroids may be administered in double or triple combination also in hypertension and COPD as well. It is important to note, that statin therapy and also vitamin D3 improve the condition of COVID-19 patients.]

Lege Artis Medicinae

JUNE 07, 2021

[COVID-19 and Parkinson’s disease]

TÓTH Adrián, TAKÁTS Annamária

[Parkinson’s disease is the elderly people’s condition which increases the risk of infections in the upper airways in its ad­vanced stages. Specific diseases (as hypertension, diabetes mellitus), older age and the male sex are significantly worsening the course of COVID-19. It would be challenging to examine parallel these diseases, since they are raising two important ques­tions. First, if Parkinson’s disease be a risk factor of COVID-19 morbidity and mortality. Se­condly, how the COVID-19 pandemic can influence the Parkinson’s disease patients. The authors are seeking answers to these questions based on the published results in the topic concerned.]

Lege Artis Medicinae

JUNE 07, 2021

[Epilepsy in coronavirus pandemic]

SZŰCS Anna, HALÁSZ Péter, NARULA Lalit

[We aim to review the impact of COVID-19 pandemic on epilepsy and epilepsy-care. While the virus has no specific link with epilepsy, it may affect the nervous system both directly and indirectly, leading to seizures in several ways. The hyper-coagulable state occurring with the infection may cause strokes leading to seizures. The infection may first manifest in the form of disturbances of consciousness and behaviour, seizures, and even status epilepticus. The interactions of antiviral/antiepileptic drugs need to be taken into account during treatment. The hypercoagulable state induced by COVID-2 infection may cause stroke, which leads to seizures. The infection can occur also as an impaired consciousness of non-epileptic origin. Interactions of antiviral/antiepileptic drugs have also to be taken into account. The pandemic itself as well as quarantines and social distancing may cause anxiety and insomnia, challenge continuous antiepileptic supply; each one carrying the risk of seizing. Young epilepsy patients with learning disabilities and mental health issues are most vulnerable, justifying their hyper-protection. The danger of infection has highlighted the role of telemedicine. Internet-based video communication may ensure full care for chro­nic patients. Those methods favour bes­­ted patients with higher education. Epilepsy does not increase directly the risk of infection, but its comorbidities may worsen the course of the disease. Brain lesions and hypoxia, stress, insomnia and fever joining the infection increase seizure susceptibility. Because the danger of infection ma­de telemedicine an essential tool of pa­tient care, education and better computer supply for those in need is crucial. ]

Lege Artis Medicinae

JUNE 07, 2021

[Potential impact of human genetic variations in COVID-19 infection ]

VÁRNAI Réka, SZENTPÉTERI L. József, SIPEKY Csilla

[The aim of COVID-19 Host Genetics Initiative (HGI) research collaboration is to identify human genetic variation that influences responses to SARS-CoV-2 infection and its subsequent disease, COVID-19. In the COVID-19 HGI consortium more than 1000 scientists share their own data. The authors of this study participate in the Hungarian communication of the published results at the request of COVID-19 HGI.]

Lege Artis Medicinae

JUNE 07, 2021

[Negative pressure wound care while covid-19 pandemic: treatment of necrotizing fasciitis and retroperitoneal abscess]

ZÁDORI Gergely, SUSÁN Zsolt, TÓTH Csaba Zsigmond, TÓTH Dezső, SZENTKERESZTY Zsolt

[Necrotizing fasciitis is a rare and high mortality condition. Most commonly it is spreading in the extremi­ties, abdominal wall soft tissues and perineal region, but occurs rarely in the retroperitoneal space too. Primary treatment is debridement with administered antibiotics, supported by negative pressure wound care. The present case report concerns a successful treatment of an extensive necrotizing fasciitis spreading from the hip region and ending up in a retroperitoneal abscess. A gradually increasing, painful, ulcerated swelling developed in the patient’s right hip region. On the first examination, elevated laboratory markers of inflammation were identified while the necrotizing lesion raised concerns of sarcomatic background. Initially, we started antibiotics and took tissue samples. The prompt CT scan confirmed a large abscess complex involving also the retroperitoneal space. The surgical exploration verified a typical necrotizing fasciitis and after removing debridement negative pressure wound care was started. After 14 days of this treatment the patient recovered successfully. Negative pressure wound therapy is pivotal in the treatment of necrotizing fasciitis. The number of wound dressings and of medical staff – patient contacts can be significantly reduced by this me­thod. It has a major advantage in the COVID-19 pandemic, since minimalizing close contacts is of vital importance in controlling the spread of the virus.]