All about coronavirus 2019-nCoV for healthcare professionals

The entry gate of SARS-CoV-2 is the mucous membranes. The virus, entering the nasal cavity with the air flow, penetrates the oropharynx, in the mucous membrane of which ACE2 receptors are located. With the help of S-proteins, which make up the “crown” of the virus, it binds to ACE2 receptors, after which the virus replication phase begins [1]. Thus, to resist infection, it is important to strengthen the local immunity of the mucous membranes. What drugs can be recommended to visitors and how to justify the recommendation?

Mucosal care products

A well-known domestic pulmonologist, academician of the Russian Academy of Sciences, Professor Alexander Chuchalin, recommends carefully caring for the mucous membranes of the nasopharynx and oral cavity to increase the local immune response as part of the prevention of COVID-19 [2]. Along with hygiene procedures, it is important to maintain optimal hydration of the mucous membranes - this will help avoid the formation of microcracks. For this purpose, you can use saline solutions, sea water solutions to irrigate the nose and throat. Let us remind you that there is no scientific evidence that regular rinsing of the nose with saline solution can protect against the new coronavirus infection. An argument in favor of using products based on sea water to irrigate the nasal mucosa is the season of hay fever, which we are gradually entering.

We must not forget that the virus can penetrate through the mucous membrane of the eyes, which also requires care. To prevent dryness of the conjunctiva of the eye, you can use ophthalmic agents designed to moisturize the mucous membrane.

The mechanism of action of Enterosgel

The active ingredient of the drug Enterosgel is Polymethylsiloxane polyhydrate. This is a polymer gel-like organosilicon compound. The hydrogel is dispersed in water to particles no larger than 300 microns in size. The drug is a suspension. The drug particles have a globular structure with a certain, specified pore size. The porous structure is formed by microgranules and the space between them filled with water.

Rice. 1. Porous structure of Enterosgel.

The structure is formed by microgranules and the spaces between them filled with water. The size and shape of the pores is determined by the diameter of the primary particles. The presence of methyl groups on the surface of Enterosgel microgranules determines its hydrophobicity.

Rice. 2. Surface of the Enterosgel globule.

On the surface of Enterosgel globules, methyl groups (-CH3) predominate, due to which the surface of the globules is hydrophobic.

The consistency and structure of Enterosgel determine its mechanism of action:

1. The porous structure of Enterosgel determines the absorption capacity by the mechanism of molecular adsorption and allows the preferential adsorption of medium-molecular toxic substances (for example, protein degradation products).
2. Thanks to its gel-like consistency, Enterosgel binds high-molecular toxic substances (for example, bacterial toxins). Elastic gel-like particles of the drug have protective properties, because form a protective layer and protect tissues from the effects of various damaging factors. These properties manifest themselves universally - in the intestines, on the surface of wounds, on mucous membranes, on the skin.

Vitamins that protect the body in general and mucous membranes in particular

Severe deficiency of any vitamin negatively affects the immune response, since each of the essential micronutrients is included in several biochemical cascades at once. For example, deficiency of vitamin C causes scurvy, B12 – corresponding anemia, which is accompanied by a significant decrease in protective functions. In this context, the optimal means of increasing the body's defenses are multivitamin complexes. However, some nutrients play a special role in the formation of the immune response, let's talk about them in more detail.

Sources

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• Zachariassen LF., Krych L., Rasmussen SH., Nielsen DS., Kot W., Holm TL., Hansen AK., Hansen CHF. Cesarean Section Induces Microbiota-Regulated Immune Disturbances in C57BL/6 Mice. // J Immunol - 2022 - Vol202 - N1 - p.142-150; PMID:30487172
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• de Lorenzi F., Loschi P., Rietjens M., Sangalli C., Manconi A., Zanagnolo V., Achilarre MT., Maggioni A., Landoni F. Neourethral meatus reconstruction for vulvectomies requiring resection of the distal part of the urethra . // Eur J Surg Oncol - 2015 - Vol41 - N12 - p.1664-70; PMID:26365756

Vitamin A to protect mucous membranes

Professor Chuchalin recommends increasing local immunity of the mucous membranes with the help of vitamin A in the midst of a pandemic [2]. It has been proven that vitamin A has a general strengthening effect, increases resistance to diseases of the mucous membranes and respiratory tract, and enhances cellular and humoral immunity.

It is known that with vitamin A deficiency, the response of T- and B-lymphocytes to a number of pathogens decreases or changes, the regulation of interferon production is disrupted, the number changes and the functioning of immune cells, in particular, monocytes and dendritic cells, is disrupted [3]. At the same time, vitamin A deficiency occurs quite often, especially in the spring, during the period of hypovitaminosis. According to statistics, about 250 million preschool children are deficient in retinol, and in at least 5 million cases it has clinical symptoms [3].

NB! Vitamin A is not recommended for use as a single drug during pregnancy without indications. Excessively high blood levels may be associated with teratogenic effects in the first 60 days after conception. But in combination with other vitamins and minerals, in a precisely calibrated safe dose, vitamin A can be included in multivitamin complexes for pregnant and nursing mothers.

The daily requirement for vitamin A for an adult is 0.9 mg [3000 IU].

Dry nasal mucous membranes

Dryness of the nasal mucosa is a sign of certain pathologies, and if left untreated, this condition threatens atrophy. To help a person with such a problem, you can consult an otolaryngologist at a medical clinic and take the necessary tests. Timely treatment will help maintain mucosal balance and avoid loss of smell.

Causes

Both external and internal factors can lead to dry mucous membranes. In the first case, dryness is a response to the irritating influence of the environment, and in the second, it is a symptom of a certain pathology.

Dry nose can also be caused by:

• bad habits, smoking (active or passive, hookahs or electronic cigarettes);
• alcohol abuse (due to the effect of toxins on the body);
• living in industrial areas where there are emissions of harmful substances into the air;
• work in hazardous conditions, in dusty rooms;
• work in a hot room, in hot air conditions;
• abuse of air fresheners;
• monotonous diet, lack of vitamins and microelements.

Vasoconstrictor nasal drops can also cause dryness if used uncontrolled, for a long time and not as prescribed by a specialist. It is best to avoid drops and, if there is no nasal pathology, install a humidifier in the room, which will relieve dryness. This is especially true in autumn-winter, when the heating season is underway and the humidity in apartments is below normal.

Features of the course of the disease

Insufficient hydration of the nasal passages is accompanied by a feeling of burning, itching and dryness. At first, dryness can be dealt with by rinsing the nose with sea water and using moisturizing drops, but in the future the situation will not improve due to the progression of the pathology.

The first manifestations of nasal dryness should not be ignored and independent treatment should be started. This may lead to an imaginary improvement, but the mechanisms themselves and the cause of the pathology cannot be eliminated. If the condition has been haunting you for several days, contact an otolaryngologist and get examined.

The nasal passages and the tissues lining them are complex. They contain special glands that produce mucus in the required volume so that the nose does not dry out and performs its functions. The regulation of the glands is very delicate; they respond to changes in the external environment, harmful effects, etc. For example, in a dusty room, more mucus is released in order to delay microparticles in time and prevent them from entering the body. These particles are removed with mucus. But in a damp room, for example, in a swimming pool, sauna or bathhouse, the mucous membrane produces less secretion due to the already moist environment around. The main role of the mucous membrane and its variable reaction is to protect the body from pathogenic microbes and dust. Microscopic villi constantly work and expel foreign bodies, protecting the body. But with insufficient mucus secretion, dryness in the nose occurs, and the tissues themselves change their structure, lose elasticity, become inflamed and swollen, and microcracks and bleeding wounds form on the surface. All this provokes unpleasant sensations.

Excessive dryness in the nose appears at any age - both children and adults can suffer from it, but the mechanisms and causes of development differ. To determine exactly why your nose is dry, a visit to the clinic is necessary.

Symptoms

Symptoms of dry mucous membranes appear in combination with other manifestations, often significantly complicating a person’s life. Doctors name among the signs:

• itching in the nose, dryness and burning, which appear due to microtrauma due to loss of moisture from the cells of the nasal mucosa;
• dry mouth and nasal congestion, which especially often manifests itself in the morning, when the mucous membrane swells at night, and in the morning a person cannot breathe normally due to congestion;
• constant dryness, accompanied by crusts in the nose, which are difficult to remove with daily cleansing, and when the crusts are forcibly removed, minor bleeding appears;
• profuse hemorrhages from the nose, when the dry mucous membrane is often injured, and nearby large blood vessels begin to bleed;
• dryness of the border near the external opening of the nose, which is accompanied by cracks, peeling, the appearance of crusts and dried blood;
• loss of smell is one of the latest symptoms that appears in the absence of proper treatment for the pathology.

Complications

In addition to the fact that dry mucous membranes in themselves are a rather unpleasant symptom, they also lead to various complications. In patients with this pathology, doctors note:

• pharyngitis;
• bronchitis;
• sore throat;
• sinusitis;
• pneumonia;
• atrophic rhinitis;
• frequent cases of ARVI.

Complications associated with dry nasal mucosa appear as a result of disruption of natural processes, when the mucous membrane ceases to perform its functions, including protective ones. Warming the air, retaining allergens from the outside, dust and tiny particles, trapping pathogenic microorganisms - all these functions when the mucous membrane is dry cease to be fully performed, so the larynx, nasopharynx, and bronchi suffer. The development of complications may be delayed if the process lasts a long time.

Dry nose as a symptom of pathologies

A feeling of dryness in the nose should alert you, since this sign may be a symptom of another disease that needs treatment. Dry nose can be caused by:

• catarrhal rhinitis - a chronic form of pathology leads to atrophy of the mucous membrane;
• hypertrophic rhinitis - pathological growth of the lining membrane, due to which the passage of air is disrupted, swelling often appears;
• scleroma - the pathology is infectious in nature and can even lead to death;
• Sjögren's syndrome - inflammation of not only the nasal mucosa, but also the salivary glands;
• diabetes mellitus is a metabolic disorder, including at the micro level, when the nasal mucosa suffers;
• hormonal changes - usually occur in older people due to a decrease in the level of sex hormones, when dry skin manifests itself throughout the entire body, and not just in the nasal passages.

Treatment for dry nose

Therapy should be carried out by a specialist, as it is important to determine the cause. Methods for eliminating pathology include:

• isotonic salt solution for irrigation of the mucous membrane from the inside - such solutions are produced based on table salt. They have a very gentle effect on the mucous membrane, improve the rheological properties of the discharge, dilute its composition and increase the activity of the epithelial cilia. The chemical composition is more reminiscent of sea water. The drugs are effective at the early stage of pathology with minor dryness;
• oils for moisturizing when crusts form - doctors recommend using peach, sea buckthorn or flaxseed, which perfectly soften crusts and help cleanse the nose. After removing the crusts, if wounds appear, the area can be treated with Solcoseryl. It is better to use oil occasionally, as it disrupts the functioning of the eyelashes, making it difficult for them to move;
• ointments with an antiviral effect - oxolinic ointment or Grippferon is used to strengthen local immunity;
• drugs against nosebleeds - for weak walls of blood vessels, the drug “Ascorutin” is recommended, which also contains vitamin C to strengthen the immune system;
• inhalations - carried out both at home and in the clinic, special drugs (isotonic solutions) are added to the inhaler, which must be inhaled in sessions on the recommendation of a doctor;
• rinsing the nose - a procedure using a weak saline solution will help get rid of dust and small foreign particles, but it must be done strictly according to indications, so as not to upset the balance of the mucous membrane.

Treatment of dry nasal mucosa must be competent. The causes are not always obvious, so only a doctor, after an examination, will determine what caused the problem and prescribe remedies to eliminate the pathology.

Author

Yampolsky Sergey Zigfridovich

otorhinolaryngologist (ENT)

Candidate of Medical Sciences

40 years of experience
+7

Vitamin D

Another fat-soluble vitamin that has a significant effect on the functioning of the immune system is vitamin D. It is known that it [4]:

• stimulates the activity of macrophages;
• induces differentiation [maturation] of immune cells;
• increases monocyte proliferation;
• increases the activity of T-regulatory cells, which regulate the strength and duration of the immune response;
• reduces the production of pro-inflammatory cytokines;
• increases the synthesis of antimicrobial peptides.

It has been proven that with a vitamin D content of more than 50 ng/ml in the blood plasma, the likelihood of developing respiratory infections is 27% lower than with severe deficiency [vitamin D level less than 20 ng/ml] [5]. At higher concentrations of the vitamin in the blood, the risk of developing influenza, respiratory syncytial virus infection, and pneumonia is reduced [6]. The decrease in the likelihood of developing the latter is associated with the beneficial effect of vitamin D on the respiratory tract: it reduces the production of cytokines in epithelial cells, reducing the severity of inflammation, and blocks the proliferation of smooth muscles of the respiratory tract [7].

The daily dose of vitamin D is 600-800 IU. For pregnant and lactating women it reaches 800-1200 IU, and for people over 50 years old 800-1000 IU.

Scheme of action of the drug Enterosgel:

• absorbs toxic substances in the intestines;
• prevents the reabsorption of toxic substances from the intestines into the blood. Thus, Enterosgel cleanses the body of toxic substances without direct contact with the blood;
• absorbs and removes toxic products of bacterial origin;
• strongly binds pathogenic bacteria and rotaviruses;
• forms a protective layer of gel-like particles;
• does not reduce the absorption of vitamins and microelements.

Diagnostics

If signs of vaginal atrophy appear, you should consult a gynecologist. The doctor will first listen to the patient’s complaints and then conduct a full examination. It is important not to hide the symptoms, but to tell the specialist exactly when the first signs began.

A gynecological examination allows you to assess the condition of the vulva and vagina. Observed:

• Swelling;
• Swelling;
• Redness;
• Pallor of the mucous membrane due to decreased blood supply;
• Possible cracks in the vestibule of a narrowed and shortened vagina.

The doctor immediately takes smears for cytology to rule out the development of cancer or precancerous conditions of the cervix. At the same stage, the specialist takes a smear for microflora, it is necessary to assess the ratio of opportunistic microorganisms, find out the presence of bacteria, viruses, and find out the pH level of the vagina.

For a more thorough examination, the doctor performs a survey colposcopy and transvaginal ultrasound. To exclude pathologies of the pelvic organs, doctors additionally prescribe a transabdominal ultrasound of the pelvic organs.

Laboratory diagnostics are also important:

• General blood analysis;
• Blood chemistry;
• Blood test for hormones;
• General and biochemical urine analysis.

Other tests may be performed to determine your general health. When prescribing a course of therapy, it is important to take into account existing pathologies.

How to suspect vaginal atrophy

The disease develops slowly, usually taking 12-24 months before the main symptoms appear. The most obvious signs are:

• Excessive vaginal dryness;
• In a calm state, itching, sometimes burning of the vagina and vulva;
• Discomfort, pain during sexual intercourse, even with sexual arousal;
• Spotting or bleeding after intimacy;
• Yellowish or gray watery discharge.

Often the regression extends to the urinary system. Then, incontinence, frequent urge to urinate, pain and burning during it join the existing symptoms.

If bacteria appear on the thinned mucous membrane, devoid of protective microflora, foul-smelling discharge is added to the main symptoms.

Most women associate the primary signs of vaginal atrophy with any other pathologies of the genitourinary system, trying to cure themselves or mask the problem (vaginal lubricants, painkillers).

Often, due to mild symptoms, the problem is postponed until later or completely written off. Sometimes there are situations when a sick person is simply ashamed to talk about a delicate illness. In all cases, refusal to seek medical help leads to significant complications.