Algorithm for diagnosis and treatment of chronic forms of venous circulation disorders

Coronavirus without symptoms

Asymptomatic patients are considered patients whose smears show SARS-CoV-2, but there are no other signs of the disease.

• Even in the first wave in the UK, according to statistics, 78% of virus carriers had no symptoms or a mild form of infection.
• According to statistics from doctors in Italy, 50-70% of people with coronavirus infection are without symptoms. Research was also conducted in the spring of 2020.
• According to Australian scientists, the disease occurs without symptoms in more than 80% of cases.
• In Russia, at the beginning of the epidemic, it was believed that asymptomatic patients could make up up to a quarter of those infected, in July 2020 they began to talk about 40-50%, and at the beginning of the second wave, doctors say: 25% of those infected have symptoms of the virus, that is, they are asymptomatic 75% of people. Thus, the new Russian data are already close to the results that were obtained in the UK in the first wave.

The difference in data arises because different countries (and at different times) test different numbers of people for coronavirus. The more people are tested, the more asymptomatic carriers and vectors are identified.

Also, the “discrepancy” in the numbers is due to the fact that in some countries asymptomatic carriers of the virus are included in the statistics of COVID cases, in others they are not. And sometimes the approach to the state of things changes, and accordingly, the graph of COVID cases may begin to go in one direction or another.

Also, in some countries, for example, in Kazakhstan, double statistics existed for a long time: those who were directly ill and those who were carriers but had no signs of the disease were counted separately. Control over the first group was stricter; for the second group, sanitary and epidemiological measures were weaker. But then a number of such countries nevertheless came to the conclusion that both people with symptoms and those without them should be counted equally.

Another question is that the former require serious treatment, the latter only require fixation (approach as for persons in contact with carriers of the virus) and take appropriate measures (self-isolation). And it is impossible to say unequivocally whether carriers with and without symptoms pose the same or different danger to others. After all, transmission of coronavirus infection is possible not only through coughing and sneezing, but also through small droplets released from the mouth and nose when talking and breathing. Moreover, if a person who is a carrier of the virus but has no symptoms is in a close, poorly ventilated room with another, the chance of becoming infected is always higher. Transmission of the virus by objects cannot be ruled out. Although scientists have a lot of controversy about this.

What percentage of asymptomatic coronavirus carriers in Belarus is currently unknown. And it is becoming increasingly difficult to obtain this data, because if at the beginning of the epidemic PCR testing was carried out not only on people with symptoms, but also on all identified first-level contacts, then from mid-November 20, 1st-level contacts were subject to PCR testing sent only if respiratory signs are present. These signs are determined on the basis of an independent assessment of one’s condition, a survey of a doctor, and, if necessary, a measurement of the level of oxygen in the blood with a pulse meter (saturation), and an examination of the throat.

In Russia, by the way, the situation is similar. From the decree of the head of Rospotrebnadzor dated November 16, 2020, it follows that citizens who have been in contact with patients with coronavirus can now leave self-isolation after 14 days without undergoing a test for COVID-19.

True, data can also be obtained based on a study of a sample of individuals who have developed antibodies. But even here, not everything is clear. There is no exact data yet on how long they remain in the body.

Forecast and preventive recommendations

As an independent disease, bettolepsy does not pose a threat to the patient’s life. However, if its signs appear, you should immediately contact a medical specialist. The doctor will plan and carry out timely treatment of the underlying disease. It is important to monitor your body weight and eat right, as obesity is one of the risk factors.

At the first signs of the development of the disease, you must constantly monitor your condition, avoid a strong cough (it occurs not only with acute respiratory viral infections, but also with strong odors, changes in temperature, going out into the cold), rest on time, do not stand for a long time, and do not overexert yourself and do not make sudden head movements.

What is the incubation period for coronavirus infection?

The incubation period for coronavirus infection in most cases is up to 10 days. The first wave was considered to be up to 14 days . In some isolated cases, the incubation period lasts about 20 days.

The highest chance of becoming infected is from a person who is a carrier of coronavirus, but until the disease is recognized - 1-2 days, as well as from a person who has been sick with COVID-19 for 1-4 days. 95% of patients thus fall within the range of two to six days. During the incubation period, SARS-CoV-2 does not manifest itself in any way.

Another difficulty is that if coronavirus is without symptoms, it is difficult to give an objective assessment of which day of illness is the first.

By the way, if we compare the incubation period of coronavirus infection and influenza, then the latter has a shorter incubation period. In the latter case, in most cases it lasts a day or two.

Description and causes of the disease

Bettolepsy is characterized as a disorder of consciousness that occurs as a result of severe coughing attacks. The degree of impairment has varying levels of severity, and can manifest itself as a slight fainting state, or a complete loss of the latter with accompanying signs of loss of control over one’s own body. According to medical statistics, the disease is extremely rare and occurs in patients suffering from primary heart and lung failure. The risk group includes men who have crossed the 45-year age threshold. Less commonly, pathology occurs in women. Of all observed states of altered consciousness, bettolepsy accounts for only 2%.

The cause of the abnormal manifestation is sudden or prolonged oxygen starvation of the brain structures, complicated by cough syndrome. Pathology develops against the background of the following main ailments:

• 
  Diseases of the respiratory system. With insufficient lung functionality, constant stagnation of the pulmonary circulation occurs, leading to the development of failure of the cardiovascular system and lungs. The severe stage leads to gradual dysfunction of areas of the cerebral cortex, which leads to such manifestations as systematic fainting with accompanying seizures.

• Thrombosis of the respiratory canals as a result of foreign elements, infectious and inflammatory processes. With severe coughing attacks, further brain hypoxia occurs, which leads to fainting.
• Degeneration of brain tissue due to destruction of the vascular network, post-traumatic condition, etc.
• Pinching or compression of the peripheral nerves responsible for cardiac activity. Episodes of slow heart rate (bradycardia) lead to a sharp reduction in blood flow to the brain, which also leads to partial or complete loss of consciousness.

There are also external factors that contribute to the development of the disease:

• smoking;
• drug use;
• excess body weight;
• frequent consumption of alcoholic beverages.

The significance of cough syndrome as a provoking factor is that during attacks there is a sharp increase in internal pressure inside the sternum and peritoneal area, which leads to a decrease in blood flow to the heart. Cardiac output loses intensity, blood slowly enters the skull, which leads to fainting symptoms.

Doctors classify three degrees of pathology:

• Short-term disorder. Fainting lasts a few seconds, does not lead to critical consequences, does not require medical attention, and goes away on its own.
• Minor fainting at the peak of cough syndrome. Lasts on average up to ten seconds.
• Prolonged fainting. Symptoms such as severe cramps, defecation and urination often occur. Brain structures are severely damaged and permanent damage occurs, leading to subsequent cognitive impairment.

More and less common symptoms

The most common symptoms with which the disease begins are respiratory (fever, cough, sore throat). At first, the disease is easy to confuse with the flu, sore throat, or acute respiratory infection.

Among the common symptoms is the loss of the ability to recognize smells (but it is important to understand that this is not an indicator, there are patients who have this symptom, but do not get sick with coronavirus, and there are people who have a moderate and severe form of the disease, but they have no taste differentiate).

If the disease progresses quickly, shortness of breath (feeling of lack of air, difficulty taking a deep breath), and chest pain are immediately added.

More rare are symptoms of a dermatological nature (rashes on the body, mucous membranes), nausea, vomiting, diarrhea, hemoptysis, unbearable headache.

Also not the most common symptoms in patients with coronavirus, but related to its symptoms, are swollen veins, cyanosis of the skin, and surges in blood pressure.

Let us consider which of these symptoms appear first, how symptoms change from day to day, whether there are differences in the manifestation of symptoms in adults and children, what you need to remember if your sense of smell has disappeared.

What is the first symptom of coronavirus?

Various symptoms can be the first to make themselves felt. But, as a rule, these are respiratory manifestations.

• Fever. In some patients the temperature is immediately above 38 °C, in some patients it is low-grade: 37.1 – 37.3 °C.
• A sore throat. Moreover, as a rule, the back wall of the throat hurts more. At the same time, there is an unpleasant taste in the mouth.
• Dry cough. A person cannot “clear his throat.” His sputum does not come out.
• Fatigue. Malaise even after minimal physical exertion.
• A slight runny nose (at first it was believed that if you have a runny nose, then it’s not Covid), but later it turned out that everything was very ambiguous. A runny nose during COVID makes itself known less often than a dry cough, but its presence or, on the contrary, absence, cannot be a signal for an accurate diagnosis.

Among the first symptoms of coronavirus is anosmia – loss of smell. At the same time, like respiratory symptoms, loss of smell or taste cannot be called a direct “indicator” of COVID-19. The same symptoms are characteristic of neurological patients (for example, this symptom is common in those suffering from Alzheimer's disease). And in some cases, this is not a sign of pathology at all, but a sign of aging (more often in men). True, if before 2020 they did not pay much attention to it, then with the mass circulation of information that this is a symptom of coronavirus, many began to focus on it. Also, people who have suffered head injuries or nasal polyps often experience loss of smell.

However, some patients are only concerned about loss of smell and fatigue. This audience is classified as patients with mild symptoms of coronavirus.

Coronavirus symptoms without fever

Without fever, coronavirus is more common in children than in adults. In this case, against the background of the absence of temperature, the patient can experience the entire symptomatic spectrum, as in a patient with fever. Starting from a sore throat, and up to coughing, severe muscle pain, severe weakness (weakness).

Moreover, if adults have symptoms of coronavirus without fever, two radically opposite “scenarios” are possible.

1. The disease occurs in a mild form.
2. The functioning of the immune system is disrupted. After all, it is important to understand that behind the rise in temperature lies the body’s mechanism for fighting the disease, working to prevent complications (for example, in the form of pneumonia).

Often, frail elderly people have no fever during COVID. Their hypothermia is often caused by regular use of drugs to treat cardiovascular diseases.

Among people who suffer from viral infections without fever, there are also many who suffer from thyroid pathologies. And the reason for this is either the improper functioning of the thyroid gland itself, or the use of drugs aimed at correcting its function.

Hypothermia is also often observed in allergy sufferers who regularly have to take antihistamines, and in people who have recently suffered any bacterial infections and have been treated with antibiotics for a long time. Moreover, these could be both infections of the respiratory tract and, for example, the genitourinary system.

Despite the fact that in weakened elderly people the disease can occur without high fever, they often have difficulty breathing, many have movement and speech disorders (in this case, the symptoms of COVID-19 are close in symptoms to a stroke, and in some carriers of SARS-CoV-2 This strain is a stroke provocateur).

Symptoms

The clinical picture of bettolepsy is considered from 4 positions:

1. The pathology is often observed in mature and elderly men who smoke and are obese. Often combined with bronchopulmonary diseases.
2. Loss of consciousness is most often caused by chronic paroxysmal cough. Coughing is accompanied by strong contraction of the muscles of the chest and abdomen.
3. Syncope can develop in any body position: lying, standing or sitting. Usually a person loses consciousness after 5 seconds of continuous coughing. Loss of consciousness is preceded by dizziness and decreased visual accuracy.
4. Syncope due to continuous coughing lasts up to 10 seconds, in rare cases, loss of consciousness lasts 3 minutes. Syncope may be accompanied by cramps and heavy sweating. Some patients experience involuntary urination or defecation.

Symptoms of coronavirus in children

About 20% of children who are carriers of SARS-CoV-2 do not notice this disease in themselves.

In most children, Covid occurs in a mild form, like a cold: the temperature rises, but is not critical, or the disease goes away without it at all, there is fatigue, a slight cough, and there are no pathological changes in the lungs.

But there are children who have a hard time with COVID-19. Most of them are among babies under one year old (more than 10%). Risk group and age 1-5 years (over 7% of children at this age require serious treatment). But among children and adolescents aged 6 - 16 years, severe disease is typical for 3 - 5%.

With moderate severity, there is lung damage (pneumonia), but there is no shortness of breath. In severe cases of the disease, in almost all cases the temperature is above 35%, problems with the lungs are serious (difficulty breathing, coughing is painful), the skin begins to turn blue. Many people have problems with the stomach and intestines. They make themselves known by diarrhea and vomiting.

Symptoms of coronavirus in infants

The most difficult thing is with symptoms in infants. After all, they cannot say what bothers them, what hurts. Some of the symptoms can easily be attributed to teething, intestinal colic: increased tearfulness, anxiety, problems falling asleep.

At the same time, for example, the same intensity of intestinal colic is a characteristic sign of coronavirus in infancy.

Respiratory manifestations most often boil down to redness of the throat, nasal congestion, coughing, while most infants do not have breathing problems.

In a number of infants, especially if the disease has severe colic, severe fever and repeated vomiting.

Symptoms of coronavirus in preschoolers and schoolchildren

In children of preschool and school age, symptoms are often vague. Many symptoms, at first glance, look like a “typical cold.” But the coronavirus may be hiding behind it. Therefore, children who have even the first signs of a “cold” – a sore throat, runny nose – are advised not to go to school or kindergarten.

Observations also show two trends:

1. Among schoolchildren, the highest transmission of the virus is from asymptomatic carriers.
2. The spread of the pathogen among children in middle and high school is higher than among children in kindergarten and primary school.

Covid on the skin

In addition to the characteristic symptoms, a number of SARS-CoV-2 carriers who have recovered from COVID also have dermatological symptoms. Most often these are red and purple bumps and redness on the skin.

• Visually, problem areas resemble areas after frostbite. As a rule, these are shapeless asymmetrical spots on the arms and legs. The formations may hurt and sometimes itch.
• Small blisters on the torso, arms and legs.
• Livedo is a red-blue network of vascular nature.

Dermatological problems can make themselves felt both at the first stage of the disease and when the disease has already developed. If we are talking only about redness and rashes, then they disappear within 2 weeks; if bumps have formed, then they can remain on the skin for several months.

In some COVID patients, the skin begins to peel off at the site of the bumps.

Spots are more typical for children, adolescents, young people, blisters - for middle-aged people, and livedo - for the elderly.

Dermatological manifestations of coronavirus infection are most often associated with overexpression of anti-inflammatory cytokines (peptide molecules), which are responsible for transmitting signals between cells. In fact, there is an “imbalance” in the body’s inflammatory response. But some rashes occur due to constant sweating at high temperatures. Infectious and allergic skin lesions are also possible.

Causes

Bettolepsy is a disorder of consciousness that develops at the peak of an intense coughing attack and is sometimes accompanied by tonic convulsions. It is more often observed with cor pulmonale or venous stasis and is associated with pathological impulses that arise in the superior laryngeal nerve, reflexogenic zones of the respiratory system, carotid sinus receptors, cerebral venous sinuses, jugular veins or the aorta. As a result, the pathogenesis of cough-brain syndrome, accompanied by increased intrathoracic pressure and brain hypoxia, leads to disturbances in the functioning of the nervous system, which are expressed in short-term loss of consciousness, headaches, amnesia or convulsions.

The following factors can cause the development of bettolepsy:

• pathologies of the respiratory system: bronchial asthma, chronic bronchitis, emphysema, fibrous-cavernous form of pulmonary tuberculosis, laryngitis, whooping cough, etc.;
• aspiration of small objects into the trachea or larynx;
• neuralgia of the superior laryngeal nerve;
• pathological changes in cerebral vessels: vascular anomalies, compression of the vertebral arteries during osteochondrosis, atherosclerosis of the vertebral arteries, etc.;
• alcoholism.

The cause of the development of cough-brain syndrome and the initial condition of the patient largely determine the severity of symptoms, the course and outcome of bettolepsy. For example, with chronic cerebral circulatory failure due to hypertension or atherosclerosis, an attack of coughing syncope can cause structural damage to brain tissue and lasting consequences.

Dental problems

Among the symptoms that were not paid attention to at first, but then noticed in a fairly wide number of patients with coronavirus, is exanthema, that is, a rash on the mucous membranes. Typically in the oral cavity.

Just by the presence of a rash in the mouth, one cannot judge that a patient has coronavirus. At the same time, if this sign is present, but there are no other symptoms, it cannot be ruled out that it is not Covid.

Although in many cases, classic enteroviral vesicular stomatitis may be behind the rash in the mouth. This is also an infectious disease, but it requires its own treatment.

A number of coronavirus patients develop ulcers and red bumps in their mouths, which can begin to bleed in spots.

Thromboembolism

Another common phenomenon that is important to consider when talking about symptoms is thromboembolism. It encounters many patients with moderate and severe forms of coronavirus.

Many people know about the serious consequences of thromboembolism. Not everything is about how she manifests herself.

Among the characteristic signs of thromboembolism:

• swelling of veins, often cervical
• blueness (cyanosis) of the face,
• drop in blood pressure.

However, again, these symptoms cannot be considered a direct signal of COVID-19. In addition to coronavirus, thromboembolism can be caused by injuries, varicose veins of the legs, the presence of a catheter, diseases associated with heart rhythm disturbances, malignant tumors, prolonged bed rest, and surgery with large blood loss. Also among the risk factors are old age, taking contraceptives and pregnancy.

In some patients, thromboembolism is not a symptom, but a complication. Most often, this again happens in older people and pregnant women. In addition, people with respiratory and heart failure are vulnerable, as well as those whose coronavirus has damaged the endothelium of blood vessels (a monolayer of vascular epithelial cells).

Tunnel consciousness, panic attacks

Among the signs of coronavirus in people with severe forms of the disease is tunnel consciousness. A person cannot concentrate on anything. He focuses only on the disease and the fears around it. He does not focus on recovery, “here and now,” but obsessively searches for the reason why he got sick, suicidal thoughts are possible.

Among the mental manifestations of coronavirus are panic attacks . Women suffer from panic attacks twice as often as men.

A panic attack is not just a feeling of anxiety, but pronounced fear, which is accompanied by a number of physically unpleasant sensations. Among them are increased sweating, trembling of fingers (tremor), nausea, upset stool, and chest pain.

The most informative evidence that this is a symptom of Covid or a classic panic attack is obtained by a test (smear), but there are also a number of other signs. The role is played by whether such signs are observed for the first time and how long the panic attack lasts. If this is a true panic attack, and not a symptom of COVID, then 15 minutes after the onset of the attack the person begins to “let go,” especially if you take deep breaths.

With COVID, this exercise most often does not help. After all, the reason is a lack of air, depression of respiratory function, and in this case only saturation of the lungs with oxygen helps to cope with the attack.

Types of attacks with panic attacks

Panic attacks are individual in nature. They differ in the symptoms and conditions that predominate in the clinical picture. Conventionally, attacks are divided into six types, unfolding as the disease progresses (from symptomatic poor attacks to extensive phobic avoidance with secondary depression):

• typical - autonomic disorders and undifferentiated phobias predominate;
• phobic - the picture of autonomic disorders is dominated by subjective fears that arise in situations that are dangerous only in the opinion of the person suffering from PA;
• affective - strong depressive tendencies, painfully low mood, negative irritability are observed;
• senestopathic - unpleasant and frightening somatic sensations of an unknown nature are emphasized (the person cannot specifically describe the painful condition);
• hyperventilation - there are pronounced breathing disorders (rapid and/or deep breathing, attacks of apnea, paresthesia and muscle pain);
• conversion - tendencies of a hysterical nature, senestopathic reactions dominate, panic is expressed insignificantly or is absent altogether;
• depersonalization-derelization - feelings of unreality of the world around us and a person’s perception of himself come to the fore.

Nocturnal panic attacks are different from nightmares and are not associated with images that appear in dreams in the second half of the night, in the REM phase - these are the dreams that a person remembers. Their occurrence is usually observed in the first half of the night, from 12 to 4 am. Similar to the “daytime” version, panic attacks at night are characterized by a sudden attack of severe fear for life (fear of respiratory arrest, heart failure) or unbearable anxiety.

Headache

8% of COVID-19 patients have headaches. Their intensity is quite strong even if there is no high temperature at the same time.

As a rule, ordinary antispasmodics, painkillers such as nemisulide, analgin for pain arising from COVID do not help much.

With such pain there are no other typical signs for other pathologies (for example, dizziness, as with hypertension, vegetative-vascular dystonia). However, the nature of headaches with Covid is also of a vascular nature. The virus negatively affects vascular endothelial cells. There are problems with blood flow. The lumen of blood vessels narrows significantly. A headache in this case is a signal of a lack of oxygen. And if this deficiency is replenished, then the headache problem is solved.

By the way, when pathologists autopsy the bodies of those who died from coronavirus and micrograph the brain, sharply narrowed blood vessels and signs of inflammation are visible. The vessel becomes unable to properly supply the brain with blood.

And also, as practice shows, about 1% of headaches during a pandemic are completely false. Suspicious people experience headaches when reading news about coronavirus, hearing news that one of their friends has contracted coronavirus (even if there was no contact with him).

Conjunctivitis with COVID

Some patients with COVID have pronounced conjunctivitis, while others do not have any traces of it.

Most often, signs of conjunctivitis are present in those individuals in whom the virus entered the body through the eyes. This is why not only masks are so useful, but also safety glasses and shields.

All types of conjunctivitis are visually similar. It is especially difficult to distinguish between different types of viral conjunctivitis (viral conjunctivitis - not necessarily caused by a strain of coronavirus). But viral conjunctivitis can be distinguished from bacterial conjunctivitis even without tests.

In the field of attention is what is separated from the eyes. If it is bacterial, it is dense, white, yellow, and if it is viral, it is watery.

It is also worth paying attention to the parotid lymph nodes. With viral conjunctivitis, the lymph nodes in most cases are painful when palpated.

Speech and movement disorders

Speech and movement disorders due to coronavirus can be observed in severe forms of the disease and direct entry of the virus into the brain.

The diagnosis in this case is COVID-19-associated necrotizing hemorrhagic encephalopathy.

Her symptoms are similar to hemorrhagic encephalopathy caused by strains of the Coxsackie A virus and H1N1 influenza.

The frequency of words in speech changes, perseverations arise - repetitions of individual words and even phrases, some phrases begin to be “swallowed”, errors in cases and word order in a sentence begin, problems arise with muscle articulation (it becomes difficult for a person to repeat a simple tongue twister even at a slow pace. Coordination of movements is also impaired.

Diagnostics

If attacks of bettolepsy occur, the patient must contact his local doctor, who will refer him for a consultation with a neurologist. To make a diagnosis, a detailed analysis of the patient’s medical history and life is carried out, the nature of the attacks is carefully studied and an examination plan is drawn up, which allows one to identify the cause of coughing fainting and carry out a differential diagnosis of bettolepsy with other diseases (for example, epilepsy).

To identify cough-brain syndrome, the following types of examinations may be prescribed:

• Valsalva maneuver;
• ECG;
• Holter monitoring;
• EEG;
• blood pressure measurement;
• Echo-CG;
• electrophysiological methods of intracardiac stimulation, etc.

In some cases, patients are advised to undergo tracheobronchoscopy.

The need for hospitalization of a patient in a hospital for examination and treatment is determined individually and depends on the possibility of identifying the causes of the development of bettolepsy in an outpatient treatment facility and the severity of the attacks. Sometimes, if the cause of consciousness disorders is unclear, the patient is advised to undergo examination at a specialized epileptological center.

Coronavirus symptoms by day

If the disease has symptoms, then it proceeds through certain phases. And each phase is characterized by its own symptoms.

Days 1-4 – phase 1 . In this phase, the following signs most often manifest themselves: fever, muscle pain, sore throat, dry cough. If the body is amenable to treatment, then improvement may begin after the 1st phase. Either the person recovers, or for another week or a week and a half there is a sluggish cold - often without a high fever, but with a “stuffed” throat, a slight cough, and fatigue.

5-10 days – 2nd phase . If the body cannot cope with the disease, then on the 5-6th day a new phase begins, which is characterized by a lack of air and the development of pneumonia. If timely measures are taken, including providing the patient with oxygen support, respiratory failure can be overcome by the 10th day of illness. As a rule, oxygen support is prescribed when saturation changes and oxygen levels are below 94-90%. In hospitals in Belarus, oxygen is supplied into the nose through a cannula, as a rule, when the oxygen level is less than 93%.

The unpleasant thing is that on the 4th day, some patients begin to believe that they are getting better (the criterion is that the cough has become wet, not dry). But a wet cough does not always mean a healthy cough. In some cases, the appearance of sputum is the result of fluid accumulation in the alveoli, and this is precisely followed by a violation of oxygen metabolism. That is why temporary relief on the 5th day may be followed by deterioration, and the 2nd phase is then inevitable.

If the patient's water-electrolyte balance is disturbed, then on days 5-10 convulsions, spasms in the gastrointestinal tract, and insomnia may also appear.

Day 10-12 – phase 3 . On the 10-12th day, in most patients the temperature returns to normal, but muscle pain and a feeling of lack of air may remain. In this case, the respiratory function is restored in some patients, while in others shortness of breath remains the main companion.

Days 13-20 – phase 4 . In this phase, symptoms remain, as a rule, in patients with severe disease. At this moment, there is a high risk that complications from the heart, kidneys, or heart may occur.

On the part of the kidneys, this is, for example, a drop in diuresis (urine volume), inhibition of consciousness; on the part of the heart, inflammation of the heart muscle. If a patient has a weak liver or has chronic diseases of this organ, then the risks of their exacerbation are high.

It is important to understand that different patients may have different “scenarios” for the development of the disease. There are cases when a coronavirus infection is asymptomatic, but then, after a person has formed antibodies, pneumonia develops. This is not a typical option, but it also occurs.

The course of the disease can be relatively mild, moderate or severe.

• Light form . Symptoms last 4-14 days. Limited to phase 1 (see above). For a number of patients, a mild form of coronavirus ends with a complete recovery, while a number have difficulties with the respiratory system (there is still a cough), liver (ALT levels increase), and kidneys. But there is no exact data on whether the coronavirus or intensive care is to blame for most problems. After all, the same level of ALT can be increased by paracetamol, antibiotics, aspirin - drugs that are important for treating COVID-19 itself, relieving symptoms, stopping the development of the disease, and they cannot be canceled, this is a greater risk for the body. But after a person has had COVID-19, it is important to monitor these indicators and support the liver and kidneys. If there are no serious chronic diseases of these organs, the body recovers over time. For example, the liver is supported with drugs based on essential phospholipids.
• The disease is of moderate severity . The patient “goes through” 2 phases of disease development. It all starts close to the flu, then pneumonia develops, which usually develops in the alveoral space (directly in the alveoli there is an exchange between air and blood). Hypoxia with moderate severity of COVID-19 is not uncommon, especially if a large area of ​​the lungs is affected, but patients usually do not require mechanical ventilation. It is possible to increase the oxygen level by supplying oxygen into the nose using a cannula, through breathing exercises, and prone position (lying on the stomach).
• Severe form of COVID-19 . Affects all phases of disease development. At the first stage there is a pronounced fever. Possible loss of consciousness. Acute respiratory distress syndrome and extensive pneumonia develop rapidly. Moreover, not only in the alveoral space, but also in the interstitial space, i.e. between partitions. In this case, pulmonary edema increases very quickly. CT scan shows a ground glass pattern. Blood clots may form in the arteries. Also, it is with pneumonia in the interstitial space that a person is more often oxygen-dependent: the natural oxygen level is low, oxygen deficiency occurs. Such patients often require mechanical ventilation, very high doses of drugs that reduce blood clotting activity.

Signs of a pathological condition

Symptoms often vary not only between different patients, but also within the same person during different seizures. There are many options for the course of an attack. Some symptoms are replaced by others, complement each other in different variations:

• 
  the starting point is a strong cough, sneezing, laughter, heavy physical activity that forces you to strain;

• slight dizziness;
• noise in ears;
• swelling of the cervical and frontal veins;
• darkening of the eyes;
• numbness of the skin on the face.

The development of fainting is not associated with the previous position of the body; in any case, the patient falls. A person can come to his senses on his own; this does not require emergency medical care. The duration of the anomaly varies from a couple of seconds to five minutes. Accompanying signs are slight or intense cramps of the limbs, cyanosis of the epidermis, lips and peripheral parts of the body, and increased sweating is observed. In severe cases, urinary incontinence and uncontrolled bowel movements occur. If the brain structures have lesions, coughing fainting becomes the impetus for a subsequent epileptic seizure.

After the patient comes to his senses, there may be complaints of short-term loss of hearing, memory, headache, and weakness. After some time, the described symptoms disappear. If there are no aggravating disturbances during an attack, there is no need to worry about changes in mental functions.

In what cases should you consult a doctor?

• If you have symptoms such as fever and dry cough, you should consult a doctor immediately.
• If the symptoms are atypical (for example, dermatological + loss of taste), but there is a suspicion that there has been contact with a carrier of the coronavirus, you should not delay visiting a doctor either.
• If you have difficulty breathing (severe shortness of breath), there is a feeling that there is no oxygen, you should immediately call an ambulance.
• The situation when a loss of smell occurred was not previously considered a reason to immediately go to the doctor, but in the current epidemic situation, with loss of smell (and especially at the same time with loss of taste), it is important to undergo laboratory diagnostics and exclude infection with coronavirus.
• If there are any manifestations of colds, a sore throat, or a runny nose, then in a pandemic, this is also a signal to see a doctor.

In a special risk group:

• Elderly people, the risk of complications is especially high in patients over 70 years of age.
• Persons with somatic diseases of the endocrine and cardiovascular systems: especially arterial hypertension, diabetes, atrial fibrillation.
• Taking hormonal medications.
• Persons with chronic respiratory diseases (COPD, asthma, pulmonary hypertension, idiopathic pulmonary hemosiderosis).
• Cancer patients.
• Persons with excess body weight and metabolic disorders.

Algorithm for diagnosis and treatment of chronic forms of venous circulation disorders

In the Russian Federation, 35–38 million people suffer from chronic venous insufficiency. Unfortunately, the stereotype according to which venous pathology is considered only a surgical pathology has led to the fact that a huge number of patients do not receive adequate medical care [1]. At the same time, changes in venous circulation are one of the important pathogenetic mechanisms for the development of vascular diseases of the brain.

Regional changes in the tone of intracranial veins lead to venous congestion and impaired cerebral circulation in atherosclerotic lesions of cerebral vessels, arterial hypertension (AH) and hypotension, chronic lung diseases, and cardiac pathology. It has been recorded that in 15% of patients with hypertension, compression of the jugular, brachiocephalic and vertebral veins is recorded, signs of impaired venous outflow of the brain occur in 91% of cases of hypertension, and in patients with stage 1-2 hypertension - in 55% of cases [2, 3] . At the same time, the compensatory capabilities of the brain and its circulatory system are so great that even serious difficulties in the outflow of venous blood may not cause clinical manifestations of increased intracranial pressure and impaired brain function for a long time [4], so early diagnosis of this pathology causes certain difficulties.

To simplify the doctor’s work, the following algorithm for diagnosing and treating chronic forms of venous circulation disorders can be used.

Algorithm for diagnosis and treatment of chronic forms of venous circulation disorders

Step 1. Identify risk factors

The doctor should always remember that venous congestion in the vast majority of cases is secondary in nature, that is, it occurs as a symptom of an underlying disease that impedes the outflow of venous blood from the cranial cavity. Therefore, diagnosis first of all involves identifying the underlying disease (Table 1).

Obstruction of venous outflow from the cranial cavity is observed in a number of diseases [5]:

• cardiac and cardiopulmonary failure;
• common pulmonary tuberculosis, pulmonary emphysema, bronchiectasis, bronchial asthma, pneumothorax;
• compression of extracranial veins - internal jugular, innominate, superior cava - by a neoplasm in the neck, aneurysm; hypertrophied neck muscles in reflex-muscular-tonic syndromes of cervical osteochondrosis;
• tumors of the brain, its membranes, and skull;
• thrombosis of veins and sinuses, infectious-toxic lesions of veins, cerebral thrombophlebitis;
• compression of the veins during craniostenosis (premature fusion of the sutures between the bones of the skull with compression, in particular, of the jugular veins), in these conditions the venous collectors dilate compensatoryly;
• asphyxia of newborns and adults;
• venous and arteriovenous hypertension;
• when nasal breathing stops;
• infectious and toxic lesions of the brain;
• with the consequences of traumatic brain injuries;
• epilepsy.

Diseases that cause disruption of venous outflow are given in Table. 1.

In addition, the development of venous encephalopathy may also be due to the classical causes of cerebrovascular pathology: hypertension, atherosclerosis, smoking, diabetes, use of hormonal drugs (estrogens), alcohol and drug abuse, use of nitrates and some vasodilators (nicotinic acid, papaverine). Venous outflow can also be impaired under physiological conditions, for example, when straining, during a prolonged cough, during physical stress, singing, playing wind instruments, childbirth, screaming, bending the head (for example, during physical exercise), in a lying position without pillows under the head, when the neck is compressed by a tight collar.

Step 2. Analysis of complaints and medical history

Disturbances of venous circulation, as a rule, are genetically determined. Currently, the role of the initial tone of the veins in the formation of venous discirculation is undeniable. Constitutional and hereditary factors are key for the development of venous dysgemia [6]. Patients with a family “venous” history usually have several typical manifestations of constitutional venous insufficiency - varicose veins or phlebothrombosis of the lower extremities, hemorrhoids, varicocele, impaired venous outflow from the cranial cavity, esophageal varicose veins. Pregnancy is often the trigger.

Typical complaints:

• morning or afternoon headache of varying intensity;
• dizziness, depending on changes in body position;
• noise in the head or ears;
• visual disturbances (decreased visual acuity, photopsia);
• “tight collar” symptom - increased symptoms when wearing tight collars or ties;
• “high pillow” symptom - increased symptoms when sleeping with a low headboard;
• sleep disorders;
• feeling of discomfort, “fatigue” in the eyes in the morning (symptom of “sand in the eyes”);
• pastiness of the face and eyelids in the morning (with a pale, purple-cyanotic tint);
• mild nasal congestion (outside the symptoms of acute respiratory infections);
• darkening of the eyes, fainting;
• numbness of the limbs.

The course of the disease has chronic, episodic and remitting variants.

Step 3. Examination of the patient

When examining the patient, a “venous triad” is detected:

1) swelling of the face in the morning after a night's sleep, which decreases significantly in the evening with sufficient physical activity; 2) cyanosis of the facial skin; 3) expansion of the saphenous veins of the neck and face.

With severe venous stagnation, patients are unable to lower their heads and remain in a horizontal position for a long time. Blood pressure (BP) in such patients is usually within normal limits, venous pressure ranges from 55 to 80 mmH2O. Art. A low difference between systolic and diastolic pressure is characteristic, in contrast to hypertension. In severe cases, epileptic seizures and mental disorders are possible [7]. Venous discirculation is characterized by a decrease in corneal reflexes. On palpation, pain is detected at the exit points of the first, less often the second, branches of the trigeminal nerve (“transverse sinus syndrome”) with the formation of hypoesthesia in the innervation zone of the first branch of the trigeminal nerve, which is probably associated with the development of neuropathy caused by venous stagnation and impaired microcirculation in the vaza system nervorum [8].

According to the type of prevailing symptom, the following variants of chronic venous insufficiency (encephalopathy) are distinguished: cephalgic, hypertensive (pseudotumorous), bettolepsy, polymorphic (scattered small-focal brain damage), sleep apnea syndrome, psychopathological/asthenovegetative [9].

Cephalgic syndrome is the most common clinical manifestation of the pathology of the venous system. As a rule, headaches increase when moving the head to the sides, changes in atmospheric pressure, changes in ambient temperature, after excitement, drinking alcohol, etc. This syndrome has a number of characteristic signs (Table 2).

Hypertension (pseudotumor syndrome) is characterized by clinical signs of increased intracranial pressure (ICP) in the absence of focal neurological symptoms and the presence of congestive optic discs [10]. Develops acutely. Patients, as a rule, complain of intense paroxysmal headaches, are euphoric, irritable, and often angry. Bradypsychism appears with slowness of movements. When examining the cerebrospinal fluid, increased pressure attracts attention. The protein content is slightly increased or normal, cytosis is not increased, serological reactions are negative. Pseudotumor syndrome in chronic venous pathology must be carefully differentiated from brain tumors.

Bettolepsy (cough syncope) is the development of short-term fainting with convulsive twitching during a coughing attack. Cases of “cough” fainting (bettolepsy) are quite rare and account for no more than 2% of patients with venous pathology. This form of venous blood flow disorder develops when:

• chronic bronchitis;
• emphysema;
• pneumosclerosis;
• bronchial asthma;
• cardiopulmonary failure.

In the pathogenesis, the main role is played by brain hypoxia, which occurs during a prolonged cough, caused by an increase in intrapleural pressure, disruption of venous blood flow in the superior vena cava system, a slowdown in pulmonary blood flow with an increase in intrapleural pressure, with a decrease in the filling of the left ventricle with blood, a slowdown in cardiac activity, and a decrease in cardiac output. . In most cases, paroxysms during coughing are not related to epilepsy, since they develop according to pathogenetic mechanisms characteristic of fainting conditions. Coughing attacks occur in patients while sitting or standing, often during or shortly after eating. Provoking factors: cold air, pungent odor, tobacco smoke, excessive laughter, etc. Simultaneously with the cough, facial hyperemia develops, followed by cyanosis with pronounced swelling of the neck veins. Usually there are no warning signs, there may only be slight dizziness. Loss of consciousness occurs within the first minute from the onset of coughing. The duration of syncope varies from several seconds to a minute. Cyanosis appears, patients often fall, often hurt themselves, the cough stops, the color of the face changes from cyanotic to marble-pale. Seizures are usually not observed (sometimes tonic seizures are possible). There is no tongue biting or involuntary urination.

Bettolepsy is observed mainly in older people with chronic diseases of the respiratory tract and lungs (pharyngitis, laryngitis, emphysema, bronchial asthma, etc.). At a younger age, the appearance of fainting when coughing is observed quite rarely, mainly in individuals with increased sensitivity of the carotid sinus, or with functional insufficiency of the mechanisms that support postural tone.

The syndrome of scattered small-focal brain lesions is clinically manifested by individual symptoms, such as asymmetry of the nasolabial folds, mild nystagmus, and slight staggering when walking. Motor, sensory, and coordination disorders are less common. Parkinson-like syndrome may develop [11].

Psychopathological and asthenovegetative syndromes are the earliest signs of venous insufficiency. They are characterized by increased fatigue, irritability, unstable or bad mood, sleep disorders in the form of constant drowsiness or persistent insomnia, autonomic disorders (unpleasant sensations from the heart, shortness of breath, hyperhidrosis of the extremities). It is possible to develop hyperesthesia (intolerance to bright light, loud sounds, strong odors), intellectual disorders (disorders of attention and memory, ability to concentrate). Headaches are often observed. Patients experience a change in mental state depending on atmospheric pressure: when it falls, fatigue increases, irritable weakness, and hyperesthesia (Pirogov's symptom) increase. In rare cases, psychosis develops with delusions and visual and auditory hallucinations [12]. Determinants of asthenia are constant complaints of increased fatigue, weakness, exhaustion after minimal effort in combination with at least two of the following complaints:

• muscle pain;
• dizziness;
• tension headache;
• sleep disorders;
• inability to relax;
• irritability;
• dyspepsia.

The most characteristic signs of asthenic disorders can be divided into several groups depending on the dominant complaints [13].

1. Physical disorders:

• muscle weakness;
• decreased endurance.

2. Intellectual disorders:

• disorders of attention, ability to concentrate;
• Impaired memory and vigilance.

3. Psychological disorders:

• lack of self-confidence;
• decreased motivation.

4. Sexual disorders:

• lack of libido;
• decreased erection.

Psychopathological and asthenovegetative syndromes predominantly develop in young and middle-aged patients.

Sleep apnea syndrome. In patients with sleep apnea, the absence of a physiological nocturnal decrease in blood pressure and impaired cerebral venous hemodynamics have been established.

Step 4. Additional research methods

For more accurate diagnosis, instrumental research methods are used: ophthalmoscopy, skull radiography (craniography), ultrasound (US) methods for studying the venous system of the brain, computed tomography or magnetic resonance imaging, cerebral angiography. When conducting any diagnostic study, it is necessary to take into account that venous circulation is extremely labile, and this is associated with the state of central hemodynamics, the respiratory cycle, muscle activity, and posture. It is advisable to conduct the examination on days with a favorable geomagnetic situation, provided that the patient does not have an increase in blood pressure at the time of examination, or complaints of headache or a feeling of “heaviness” in the head during the last week. Patients should not drink alcohol for several days. In women of reproductive age, it is advisable to assess cerebral hemodynamics in the first half of the menstrual period.

Craniograms can reveal an increase in the vascular pattern, expansion of diploic veins, and venous outlets. Ophthalmological methods allow already in the early stages of vascular diseases of the brain, along with changes in the arteries, to detect the dilation of veins, their tortuosity, uneven caliber, and with a pronounced increase in intracranial pressure - congestion in the fundus. The methods of biomicroscopy of the conjunctiva of the eyeball and venous ophthalmodynamometry are quite informative. To clarify the causes and extent of impairment of venous outflow at the neck level, duplex ultrasound scanning (USDS), selective contrast venography, scintigraphy and computed tomography are used. Each of these methods has advantages and disadvantages. Ultrasound scanning makes it possible to reliably assess the speed of blood flow and the relationship of blood vessels with surrounding tissues, but has limitations since a relatively small area of ​​the brachiocephalic veins is available for study. Selective contrast venography is associated with a certain risk when administering a contrast agent, which is often unjustified for this pathology [15]. Scintigraphy does not provide information about the structures surrounding the veins. Standard computed tomography allows assessing the diameter of the veins and their relationship with surrounding structures only in cross sections, but does not display the characteristics of blood flow, and in addition, is accompanied by radiation exposure. Magnetic resonance venography of the brain is characterized by a decrease in the intensity of the blood flow signal, up to its loss, in the superior sagittal sinus, great cerebral vein and straight sinus. It is also possible that there is a decrease in size or a complete absence of the signal from the blood flow along the transverse and sigmoid sinuses, the internal jugular vein of one of the hemispheres of the brain, combined with the expansion of these venous structures on the opposite side; expansion of emissary and superficial cerebral veins [16].

Step 5. Choice of therapy

Unfortunately, the issues of pharmacotherapy of cerebral venous circulation disorders still remain controversial and insufficiently studied; there is no doubt that, first of all, it is necessary to treat the underlying disease. The earliest possible energy correction can additionally affect the survival of neurons, reduce damage to brain tissue caused by chronic ischemia and hypoxia, and primarily affect the core of the asthenic syndrome - hypoergosis with increased exhaustion of mental functions [17]. Taking into account modern ideas about the pathogenesis of venous encephalopathy, the main efforts should be aimed at eliminating the following pathological factors:

1) normalization of the tone of the venous bed; 2) leukocyte aggression and inflammation; 3) correction of microcirculatory disorders; 4) increasing the capacity of the venous bed.

In the treatment of chronic disorders of venous blood flow at various stages, pharmaceutical drugs belonging to various groups (anticoagulants, agents that improve microcirculation, venotonics) are most often used. The spectrum of action of most drugs is quite narrow (dextrans affect blood rheology, antiplatelet agents reduce platelet aggregation activity, venotonics improve the tone of the venous wall, vasodilators enhance the hypotonic effect, etc.), therefore, to achieve an optimal therapeutic effect, it is necessary to use several drugs of different groups [ 2]. In recent years, there has been a search for an ideal drug for the treatment of disorders of cerebral venous circulation, which should affect as many pathogenetic links as possible, have a minimum number of side effects and high bioavailability. Naturally, the greatest interest is in drugs that have energy-correcting and microcirculatory mechanisms of action in the spectrum of their pharmacological activity with the maximum possibility of combination with venotonic drugs.

Treatment of venous circulation disorders

Clinical symptoms of brain damage in the initial stages of venous circulation disorders are minimal, but the microvasculature is already damaged, which leads to further progression of the pathological process, thus, the basic therapy is the prescription of drugs that have an angioprotective effect.

Angioprotectors

The first group of basic therapy is angioprotectors - drugs whose main effect is to restore vascular tone and their permeability. As a rule, they also have a multimodal mechanism of action.

One of these pharmacological agents is Actovegin, a drug that activates metabolism in tissues, improves trophism and stimulates regeneration processes. Of particular importance in its mechanism of action is the activating effect on the energy metabolism of cells of various organs [18]. This is due primarily to the ability to increase the uptake and utilization of glucose and oxygen, leading to improved aerobic energy production in the cell and oxygenation in the microcirculatory system. At the same time, anaerobic energy exchange in the vascular endothelium improves, accompanied by the release of endogenous substances with powerful vasodilating properties - prostacyclin and nitric oxide. As a result, organ perfusion improves and peripheral resistance decreases [19]. This mechanism ensures stabilization of the functional metabolism of tissues under conditions of temporarily induced stress and hypoxia in peripheral arterial disorders. Improvement in the processes of tissue utilization of oxygen and glucose is not isolated, but is associated with changes in the functional state of both the blood inflow pathways to the capillaries (arterioles) and the blood outflow pathways (postcapillary venules), as well as with changes in hemodynamic parameters at the capillary level [20].

A structural feature of precapillary arterioles is that there are no elastic elements in their wall, the number of smooth muscle elements is minimal, and neighboring muscle cells spiraling around the endothelial tube are located at a considerable distance from each other [21]. As a result, along the precapillary arterioles there are areas in which the vascular wall consists only of endothelial cells, outside of which there is a basement membrane, which allows them to be compared with venous vessels. Changes in the functional state of the microvascular bed, as an integral part of the cardiovascular system, affect the parameters of central hemodynamics, and, in particular, the venous system. There are probably also correlations between the functional state of the tone-forming links of microblood flow modulation and the level of blood pressure; a slight but significant decrease in diastolic (p < 0.03) and mean blood pressure (p < 0.04) is associated with a decrease in the tone of precapillary arterioles [22]. Considering the close relationship of metabolic and hemodynamic processes at the level of the microcirculatory bed, changes in the functional activity of all three tone-forming mechanisms of blood flow modulation, recent studies have proven the role of Actovegin as a corrector of microcirculation disorders [18–22]. The use of the drug resulted in a unidirectional change in the functional activity of all three tone-forming mechanisms of blood flow modulation, a significant increase in the amplitude (decrease in tone) of the myogenic rhythm on average for the group by 54% (p < 0.03) and the amplitude of the neurogenic rhythm by 50% (p < 0.003) ), and therefore Actovegin has a pronounced vasomotor component. An indicator of the metabolic activity of the microvascular endothelium is a decrease in the size of the pericapillary zone, which reflects the degree of hydration of the interstitial space. A significant decrease in the size of this zone against the background of the drug’s action confirmed that reabsorption processes predominate in the filtration-reabsorption metabolic mechanism. The filtration-reabsorption mechanism of exchange is directly related to the hemodynamic parameters of the blood flow, since it is based on the difference between the hydrostatic and colloid-osmotic pressure of the blood. Filtration processes are associated directly with the amplitude of pulse oscillations, which reflects the hemodynamic parameters of arterial blood flowing into the microcirculatory bed, and reabsorption processes with the amplitude of the venular rhythm. The results obtained during the study demonstrated the close relationship between metabolic processes and microhemodynamics and, as a final result, the possibility of using Actovegin as a means of basic therapy in patients with chronic forms of venous circulation disorders. The advantages of Actovegin include its low toxicity and good tolerability. The only contraindication to the use of the drug is hypersensitivity. Recommended regimen: 200 mg 2-3 times a day orally for a long period of 3-6 months. Courses can be held twice a year, preferably in spring and autumn.

In hospital settings, it is possible to prescribe the drug parenterally. The clinical effect is usually achieved gradually (within 3–4 weeks), and therefore the average duration of use is 1 to 3 months. Repeated courses of treatment are recommended.

Venotonics

The second group of basic therapy drugs are venotonics. Venotonics can be divided by origin into preparations from herbal raw materials and synthetic preparations.

Derivatives of ergot alkaloids (dihydroergotamine mesylate, ditamine, clavigrenin, ergotamine) are preparations from plant materials that have pronounced α1- and α2-adrenergic blocking activity, dilate peripheral vessels, increase venous tone.

Venoruton stimulates the release of endothelin from endothelial cells, which, by activating the endothelium-A receptors of the myocyte membrane, stimulates the contractile apparatus of the smooth muscles of the veins and increases the tone of the vascular wall.

Troxevasin increases the production of endothelin by endothelial cells, which, by activating endothelium-A receptors of the SMC membrane, stimulates the contractile reactions of venous myocytes and causes an increase in the tension of the vascular wall.

Detralex is a synthetic drug that reduces the distensibility of veins and venous stasis and reduces capillary permeability and increases resistance. In the presence of chronic venous circulation disorders, the maximum effect of treatment is ensured in combination with a certain, well-balanced lifestyle, in which it is recommended to avoid long exposure to the sun, reduce body weight, go for walks and, in some cases, wear special stockings that improve blood circulation.

Unfractionated and low molecular weight heparins increase the production of nitric oxide by endothelial cells, which leads to dilatation of the saphenous vein. In the portal vein, which has spontaneous phasic activity, heparins stimulate endothelial nitric oxide synthase, as a result of which the tone decreases and the frequency of phasic contractions decreases and, according to the mechanism of chronoinotropic dependence, the amplitude of phasic contractions of smooth muscles increases.

However, these drugs are used primarily for the treatment of varicose veins of the extremities or as a complement to the main treatment for venous encephalopathy.

Drugs for symptomatic treatment

Therapy for cephalgic syndrome, which often occurs in the form of tension headaches, consists of normalizing venous outflow by eliminating the increased tone of the pericranial muscles and benign intracranial hypertension. The drugs of choice in this case are muscle relaxants and diuretics.

The main diuretic drug is acetazolamide (Diacarb), used in a dosage of 250 mg 3 times a day. According to recent studies, the use of Diacarb can reduce the frequency and duration of sleep apnea by 6 months after taking it for 1 month [23]. Precautions must be taken when using acetazolamide.

1. Use with caution in patients with a history of thromboembolic syndrome and in persons with pulmonary emphysema.
2. The simultaneous use of Diacarb and acetisalicylic acid is not recommended.
3. With long-term use, it is necessary to monitor the level of blood electrolytes, the number of platelets and leukocytes, as well as the acid-base status.

In conclusion, I would like to emphasize that chronic forms of venous circulation disorders are a common pathology in clinical practice today. It should be noted that making a diagnosis at the initial stages may not even require expensive diagnostic methods; it is sufficient to carry out a thorough analysis of complaints and the clinical picture at the stage of the patient’s first treatment. Identification of characteristic “venous complaints” allows for timely complex therapy including drugs that have a venotonic effect with an adequate treatment period (at least three months), which will minimize pathological changes in the venous bed and eliminate the phenomena of cerebral ischemia and hypoxia.

Literature

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2. Mishchenko T. S., Zdesenko I. V., Mishchenko V. N. Therapeutic possibilities for the treatment of cerebral venous disorders // International Neurological Journal. 2011, 1, p. 39.
3. Savelyeva L. A., Tulupov A. A. Features of venous outflow from the brain, according to magnetic resonance angiography // Bulletin of the Novosibirsk State University. Series: Biology, clinical medicine. 2009. T. 7, issue. 1, p. 36–40.
4. Svistov D.V. Pathology of the sinuses and veins of the dura mater // Health of Ukraine. K., 2004, No. 9, p. 3.
5. Manvelov L. S., Kadykov A. V. Venous insufficiency of cerebral circulation // Atmosphere. Nervous diseases. 2007, no. 2, p. 18–21.
6. Putilina M.V., Ermoshkina N.Yu. Venous encephalopathy // Journal of Neurology and Psychiatry named after. S. S. Korsakova. 2013, v. 113, no. 4, p. 26–34.
7. Chukanova E. I., Chukanova A. S., Daniyalova N. D. Cerebral venous disorders: diagnosis, clinical features // Neurology. Neuropsychiatry. Neurosomatics. 2014, no. 1, p. 26–34.
8. Berdichevsky M. Ya. Venous discirculatory pathology of the brain. M.: Medicine. 1989. 224 p.
9. Caso V., Agnelli G., Paciaroni M. Frontiers of Neurology and Neuroscience. Handbook on Cerebral Venous Thrombosis. 2008. V. 23.
10. Kholodenko M.I. Disorders of venous circulation in the brain. M.: Publishing house of medical literature, 1963. 226 p.
11. Neimark E. Z. Thrombosis of intracranial sinuses and veins. M.: Medicine, 1975.
12. Shemagonov A.V. Chronic cerebral venous discirculation syndrome. www.medicusamicus.com.
13. Skorobogatykh K.V. State of the intracranial venous system in patients with chronic tension-type headache. Author's abstract. ...cand. honey. Sci. M., 2009. 27 p.
14. Putilina M.V. Asthenic disorders in general medical practice // Nervous diseases. 2014, no. 4, p. 26–34.
15. Savelyeva L. A., Tulupov A. A. Features of venous outflow from the brain, according to magnetic resonance angiography // Bulletin of the Novosibirsk State University. Series: Biology, clinical medicine. 2009, vol. 7, issue. 1, p. 36–40.
16. Skorobogatykh K.V. State of the intracranial venous system in patients with chronic tension-type headache. Author's abstract. ...cand. honey. Sci. M., 2009. 27 p.
17. Putilina M.V. The role of arterial hypertension in the development of chronic cerebrovascular accident // Journal. neurology and psychiatry named after. S. S. Korsakova. 2014, no. 9, p. 119–123.
18. Nordvik B. Mechanism of action and clinical use of the drug Actovegin. Actovegin. New aspects of clinical application. M., 2002. pp. 18–24.
19. Fedorovich A. A., Rogoza A. N., Kanishcheva E. M., Boytsov S. A. The effect of the drug Actovegin on the metabolic and vasomotor functions of the microvascular endothelium in human skin // Rational pharmacotherapy in cardiology. 2010, No. 1, vol. 6, p. 119–123.
20. Fedorovich A. A. Non-invasive assessment of vasomotor and metabolic function of microvascular endothelium in human skin // Regional blood circulation and microcirculation. 2013, No. 2 (46), p. 15–25.
21. Hayward CS et al. Assessment of endothelial function using peripheral waveform analysis // J. Am. Coll. Cardiol. 2002, No. 40, p. 521–528.
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M. V. Putilina, Doctor of Medical Sciences, Professor

GBOU VPO RNIMU im. N. I. Pirogova Ministry of Health of the Russian Federation, Moscow

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How to influence COVID symptoms with breathing exercises?

Exercises that are aimed at optimizing air exchange in the alveoli of the lungs also help to reduce a number of symptoms (if the disease is not severe) or increase the speed of treatment in severe forms of the disease.

Exercises based on quick short breaths of air through the nose and passive exhalation give good results.

In addition to the fact that exercise saturates the body with oxygen, blood circulation improves and lymphatic drainage is put in order. Breathing exercises are also useful for combating inflammatory processes. The optimal option is about 30-40 breaths, 3-6 seconds of rest and cyclic repetition of the exercises 3-4 times. It is best to do exercises in a well-ventilated area on an empty stomach, or if you feel very weak, 1.5-2 hours after eating.

Hypertension is a contraindication for performing breathing exercises. Exercise can further raise your blood pressure.

Coronavirus prevention measures

• Wear masks, medical respirators, disposable gloves, and eye shields.
• Wash your hands regularly and treat them with antiseptics that contain 70% alcohol. Also treat handles, window sills, and tables with disinfectant solutions.
• Ventilate the room often.
• Maintain a sufficient level of humidity in the room (40-60%), use humidifiers if necessary.
• Rinse mucous membranes with saline solutions. They can be purchased at the pharmacy or prepared from table sea salt.
• Take vitamins, including vitamin D and B vitamins.
• Do breathing exercises and strengthen your lungs. They will not help avoid infection, but will help the body avoid severe disease.

conclusions

• The most common symptoms of coronavirus are fever, weakness (weakness), dry cough, loss of smell; in complicated and severe forms of COVID there are serious difficulties with breathing.
• Both adults and children can get sick, with or without severe symptoms. But there are more asymptomatic patients among children than among adults.
• Much depends on how the virus entered the body. If through the eyes, inflammation of the eyeball is pronounced. If the virus is transmitted by airborne droplets, the first symptoms include a sore throat and cough.
• A number of patients have dermatological signs in addition to the characteristic respiratory signs.
• Loss of smell is a common, but not essential, symptom of coronavirus. At the same time, it is also not worth considering the loss of charm as the presence of coronavirus. Often this is a signal of other pathologies.
• To reduce symptoms, it is important to start timely treatment, monitor nutrition, and do breathing exercises.
• At increased risk are the elderly, people with impaired metabolism, blood clotting problems, and a weakened immune system. The course of the disease in them is more difficult, and the symptoms are more pronounced.
• If coromavirus is in a mild form, then there is no difficulty breathing, but if it is severe, this is one of the common difficulties in treating the disease.
• The most complex symptoms are in patients with respiratory distress syndrome. With it, the attack begins on healthy tissues of the body.

Follow sanitary and hygienic rules; if symptoms appear, consult a doctor immediately, do not panic.

How to identify the disease?

To determine the root cause of the disease being studied, a complete diagnostic examination is required, including measures such as:

• 
  Consultations with specialized doctors - therapist, cardiologist, neurologist. Specialists examine the history of the disease in detail, study the signs, consider the constitution of the body, age category, etc.

• Vagal testing with pressure on the carotid sinus.
• Electrocardiogram of the heart. Designed to identify disorders in the cardiovascular system. In some cases, stress testing and a study of daily heart function are required.
• EEG. During the examination, abnormal impulses emanating from various areas of the brain are captured. If affected areas are present in the organ, this may be the cause of convulsive manifestations during the activity of the syndrome.
• Study of the state of functionality of the respiratory system. It is carried out using instrumental techniques - endoscopy, radiography, computer or magnetic resonance scanning. These methods make it possible to identify the presence of chronic diseases of the respiratory organs and the presence of foreign objects in the airways.