Neuroprotection in outpatient treatment of post-covid syndrome

The aim of the study was to investigate the effectiveness of including cytoflavin in the complex outpatient therapy of patients with post-COVID syndrome.

 Materials and methods: the results of outpatient treatment of 106 patients (49 men and 57 women, average age 52.4 ± 5.2 years) with post-COVID syndrome were analyzed. In addition to standard clinical and laboratory observation, the HADS scale was used to assess the severity of anxiety and depression, and the general clinical impression — CGI-S. Spirometry, Stange, and Genchi tests were used to assess the state of the respiratory system. Patients were randomly divided into two groups comparable in gender and age. The examination was carried out before the start of treatment and after the end of the course of therapy (on the 30th day). In the main group (I, n = 56), in addition to standard drug therapy, psychotherapy, exercise therapy and vacuum therapy on the thoracic and lumbar spine, cytoflavin was prescribed: 20.0 ml intravenously by drip in 200 ml of 0.9% sodium chloride solution for 10 days, then 2 tablets 2 times a day for 20 days. Patients in the comparison group (II, n = 50) received 10.0 ml of placebo diluted in 200.0 ml of 0.9% sodium chloride solution daily by intravenous drip, followed by taking the tablet form of vitamin B12 1 tablet 1 time per day for 20 days.

Results: the inclusion of cytoflavin contributed to a more pronounced positive dynamics of clinical indicators (“chest pain” — 6 times in Group 1 and 2.2 times in the comparison group, “headaches” — 7 and 3 times, respectively, and “tachycardia” — 5.2 and 3 times, respectively (p < 0.01). Spirometry also revealed a more pronounced positive dynamics of external respiration indicators: deeper and slower breathing, relatively high ventilation reserve indicators, a longer time during the Stange and Gench tests. Against this background, a decrease in the level of anxiety and depression (according to the HADS scale) was noted: the frequency of recording atypical depressive symptoms decreased according to the “anxiety” indicator by almost 9 times in the main group and only 2.5 times in the comparison group, according to the “clinical depression” indicator — 12.5 and 5.5 times, respectively (p < 0.01). As a result, the majority (90.9%) of patients who received in the therapy scheme cytoflavin, the treatment was recognized as effective (according to the CGI scale).

 Conclusion. Тhe results obtained, along with good tolerability of the drug, allow us to recommend its use in outpatient complex therapy of patients with post-covid syndrome.

1. URL: https://www.worldometers.info/coronavirus/

2. Kanorskij S.G. post-Covid syndrome: prevalence and pathogenesis of organ damage, directions of correction. Systematic review Kubanskij nauchnyj meditsinskij vestnik. 2021;28 (6):90–116. (In Russ.). https://doi.org/10.25207/1608-6228-2021-28-6-90-116

3. Temporary methodological recommendations “Medical rehabilitation for new coronavirus infection” (COVID-19) M., 150 p. (In Russ.)].

4. Zhou H, Lu S, Chen J, Wei N, Wang D, Lyu H, Shi С., Hu S. The landscape of cognitive function in recovered COVID-19 patients. Journal of Psychiatric Research. 2020;129:98–102. https://doi.org/10.1016/j.jpsychires.2020.06.022

5. Khaibullina DKh, Maksimov YN. Asthenic post-COVID syndrome. S.S. Korsakov Journal of Neurology and Psychiatry. 2023;123 (3):61–69. (In Russ.).]https://doi.org/10.17116/jnevro202312303161

6. Ali Awan H, Najmuddin Diwan M, Aamir A, Ali M, Di Giannantonio M, Ullah I , Shoib S, De Berardis D. SARS-CoV-2 and the Brain: what do we know about the causality of ‘cognitive COVID? Journal of Clinical Medicine. 2021;10 (15):34–41. https://doi.org/10.3390/jcm10153441

7. Arutyunov A.G., Seferovich P., Bakulin I.G., Bakulina N.V.,Batyushin M.M., Boldina M.V., Krshtashich G., Matsut Dzh., Salukhov V.V., SHimosava T., SHustov V.V., Tarlovskaya E.I., Vrtovets B., Vanner K., Ajsanov Z.R., Arutyunov G.P., Avdeev S.N., Babin A.P., Kattaneo M., CHesnikova A.I., Ezhov M.V.,Kamilova U.K., Koziolova N.A., Lopatin YU.M., Mit’kovskaya N.P., Morais ZH., Galstyan G.R., Sarybaev A.SH., Sugraliev A.B., YAvelov I.S., Esayan A.M., Zolotovskaya I.A., ZHangelova SH.B., Zyryanov S.K., Mel’nikov E.S., Bashkinov R.A., SHlyakhto E.V. Rehabilitation after COVID-19. Resolution of the International Council of Experts of the Eurasian Association of Therapists and the Russian Cardiology Society. Rossijskij kardiologicheskij zhurnal. 2021;26 (9):46–94. (In Russ.).] doi:10.15829/1560-4071-2021-4694

8. Jha NK, Ojha S, Jha SK, Dureja H, Singh SK, Shukla SD, Chellappan DK, Gupta G, Bhardwaj S, Kumar N, Jeyaraman M, Jain R, Muthu S, Kar R, Kumar D, Goswami VK, Ruokolainen J, Kesari KK, Singh SK, Dua K. Evidence of Coronavirus (CoV) Pathogenesis and Emerging Pathogen SARS-CoV-2 in the Nervous System: A Review on Neurological Impairments and Manifestations. Journal of Molecular Neuroscience. 2021;19:1–18. https://doi.org/10.1007/s12031-020-01767-6

9. Abebe EC, Ayele TM, Muche ZT, Dejenie TA Neuropilin 1: a novel entry factor for SARS-CoV-2 Infection and a Potential Therapeutic Target. Biologics. 2021;15:143–152. https://doi.org/10.2147/BTT.S307352

10. Maksimova M. YU. Combined eff ect of succinic acid, riboxin, nicotinamide, ribofl avin in the treatment of chronic cerebral ischemia. Meditsinskij sovet 2022;16 (21):20–26. (In Russ.).] https://doi.org/10.21518/2079-701X-2022-16-21-20-26