Feasibility of an integrated approach to the treatment of liver diseases in various patients during post-COVID-19 rehabilitation
DOI: 10.32364/2587-6821-2021-5-6-413-420
G.B. Selivanova, N.G. Poteshkina
Pirogov Russian National Research Medical University, Moscow, Russian Federation
COVID-19 pandemic has made the problem of its complex pharmacotherapy urgent, taking into account the common presence of symptoms from the digestive system in the clinical picture. The gastrointestinal tract (GIT) is actively involved in the pathogenesis of COVID-19 both in the period of prodromal events and the acute disease phase, with the preservation of several complaints and during the post-COVID-19 syndrome. The liver is one of the main organs that is commonly affected by COVID-19 after the respiratory system. The polyetiological nature of liver lesions in COVID-19 includes the following: direct viral damage to hepatocytes and cholangiocytes, systemic inflammatory response and cytokine aggression, reactive hepatitis, drug toxicity, hypoxia associated with acute respiratory distress syndrome, as well as sepsis and multiple organ dysfunction in terminal patients. Special attention should be paid to the liver condition in COVID-19 in comorbid patients with m etabolic syndrome and non-alcoholic fatty liver disease, as well as chronic liver diseases with a history of viral and autoimmune genesis. Rehabilitation issues concerning patients after COVID-19 are currently under active development. At the same time, the experience of clinical cases leaves no doubt that it is necessary to take into account the hepatobiliary system condition and the presence of comorbidity when implementing rehabilitation programs. Methods customization to the issues of early recovery of post-COVID-19 patients implies knowledge of the differentiated use of hepatotropic drugs based on Russian and foreign clinical recommendations.
Keywords: liver diseases, COVID-19, rehabilitation, essential phospholipids, milk thistle extract, non-alcoholic fatty liver disease, cytokine damage, angiotensin converting enzyme, liver transaminases, drug-induced liver injuries.
For citation: Selivanova G.B., Poteshkina N.G. Feasibility of an integrated approach to the treatment of liver diseases in various patients during post-COVID-19 rehabilitation. Russian Medical Inquiry. 2021;5(6):413–420 (in Russ.). DOI: 10.32364/2587-6821-2021-5-6-413-420.
Aknowledgement
Editorial Board is grateful to Canonpharma Production JSC for their assistance in the technical editing of this publication.
About the authors:
Galina B. Selivanova — Dr. Sc. (Med.), Professor, Professor of the Department of General Therapy of the Faculty of Additional Professional Education, Pirogov Russian National Research Medical University; 1, Ostrovityanova str., Moscow, 117997, Russian Federation.
Natalia G. Poteshkina — Dr. Sc. (Med.), Professor, Head of the Department of General Therapy of the Faculty of Additional Professional Education, Pirogov Russian National Research Medical University; 1, Ostrovityanova str., Moscow, 117997, Russian Federation; ORCID iD 0000-0001-9803-2139.
Contact information: Galina B. Selivanova, e-mail: galina.selivanova@rambler.ru.
Financial Disclosure: no authors have a financial or property interest in any material or method mentioned.
There is no conflict of interests.
Received 14.07.2021.
Revised 06.08.2021.
Accepted 31.08.2021.
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