The latest trends in the treatment of COVID-19 patients applied

During the most severe pandemic that happened to humanity after the Second World War – the COVID-19 pandemic – the main goal of our clinic is to contribute to health preservation by providing the best medical care for each patient through integrated medical practice, education and research.

COVID 19 patients are a serious challenge for treatment because there is currently no targeted therapy and treatment is mainly supportive. Patients with severe form of respiratory failure develop a severe inflammatory syndrome, which is accompanied by the release of so-called inflammatory mediators leading to multiple organ failure and death.

Following the world trends in treating the most severely ill patients in the intensive care units, we at the Zan Mitrev Clinic have been successfully using the method of blood hemofiltration with a special highly absorbent filter (Oxiris) for many years. Our success stories related to venovenous hemodiafiltration with Oxiris filter have been presented at many world-class medical conferences as well as through publications in renowned medical journals. A proof of our compliance with the highest medical standards was the official recognition of the Oxiris filtration by the FDA in April 2020 as part of the COVID-19 treatment. By increasing our medical knowledge and following the latest recommendations for the treatment of COVID-19 patients, we have started another type of blood purification based on the method of hemadsorption of cytokines and other inflammatory mediators with CytoSorb filter (FDA approved for treating critically ill COVID-19 patients). Our initial experiences of using both forms of blood purification are excellent and represent motivation and hope for curing the most severely ill patients struggling not only with COVID-19 infection but also with other forms of inflammatory diseases of both bacterial and viral nature. Filtration is slow, safe, and usually lasts between 12 and 48 hours. During that time, patients are monitored with the most sophisticated electronic laboratory system for the level of inflammatory markers (IL 6, CRP, PCT, etc.) and depending on the results, the therapy is continued or discontinued. The only limiting factor in our country is that these forms of treatment are not recognized by the Health Insurance Fund of the Republic of North Macedonia and their use, as well as continuation of the therapy when there is improvement is limited or disabled for financial reasons.

Based on the great experiences, which are published and recognized worldwide, the Zan Mitrev Clinic will continue to strive for the highest standards in care and treatment of the most severely ill patients by following the motto of Immanuel Kant: ”People have a dignity, but not a price!” Human life is priceless!

 

Recent studies conducted by a German team of doctors show that COVID-19 infection, regardless of the severity and overall course of the acute illness, strongly affects the cardiovascular system, thereby severely impairing cardiac function.

This is a conclusion based on the results of the analysis of cardiovascular magnetic resonance imaging in patients recently recovered from COVID-19 illness.

The study includes a representative sample of 100 recovered patients, in the period between April and June 2020. The patients were identified from the University Hospital Frankfurt COVID-19 Registry. The parameters in these patients show that whether or not they have previously had any cardiovascular disease, the consequences of the infection on the cardiovascular system are significant.

You can read the original study here: https://bit.ly/3klpfuU

A five-day-old newborn was hospitalized at our clinical hospital due to a complex heart defect -Pentalogy of Fallot, characterized by cyanosis (bluish discolouration) or a decrease in oxygen saturation.

From the third day following its birth, cyanosis and desaturations occurred to the baby. Hence, it was transferred to a children’s clinic, and from there after being diagnosed with a congenital heart defect to our clinic.

In the case of the newborn, it was a complex cyanotic heart defect Pentology of Fallot (in addition to the characteristic 4 defects in our patient, there was another anomaly and that was a communication between the two atria of the heart). Due to the complexity of the defect, immediately after the newborn was admitted to the hospital, the prostaglandin therapy was continued, which served (Dukutus arteriosus) communication, present in the fetal period, to remain; which in the case of our patient enabled the blood supply to the lungs.

Due to the constant presence of cyanosis, it was decided the patient to undergo a surgery immediately. During the surgery, all the heart abnormalities present in our patient were corrected. The postoperative treatment consisted of regular monitoring of all vital parameters and a complete medical support.

During the following days, its general condition gradually stabilized, hence we started feeding the newborn, initially with milk formula and after its mother was accommodated in the hospital she started breastfeeding her baby.

After about ten days spent in our hospital, the newborn went home with his parents in a solid stable condition. After the complete surgical correction of the heart defect in our patient, a period of normal growth and development is to follow, without the necessity of repetitive surgical interventions.

 

On 10 April 2020, the US Food and Drug Administration (FDA) issued an emergency use authorization for the blood purification system for the treatment of patients with confirmed Coronavirus disease (COVID-19) aged 18 or older admitted to the intensive care units (ICU) with confirmed or expected respiratory failure.

With this type of treatment and filter (which we now also use in patients with severe Covid -19 infection), our hospital has excellent experience since 2008 in the treatment of patients with severe viral and bacterial diseases, and also in patients with systemic inflammatory response, a condition that is common and a serious complication in cardiac surgery patients.

Blood Purification Devices EUAs

Baxter Obtains U.S. FDA Emergency Use Authorization for Oxiris Blood Purification Filter for COVID-19 Treatment

Oxiris Info

When someone gives testimony about what they have experienced in the most difficult moments of their life, it is considered the most sincere testimony that remains embedded forever in the psyche of all those who shall see, read or hear the testimonial.

Here, we share such testimonial from one of our patients who has wanted to share the moments from her experience at our clinic in the past few days and what to her meant a fight for life.

The 55-year-old B.K. having all Covid – 19 infection symptoms and a positive swab, started her treatment in one of the state hospitals, after which her condition drastically deteriorated and she decided to continue the treatment in Zan Mitrev Clinic.

• Only a few days after the first symptoms I felt difficulty in breathing and I was diagnosed with double pneumonia. I was hospitalized in a state hospital where despite the care given, my condition deteriorated rapidly and drastically and there was a sharp decrease in the work and capacity of the lungs and an increased load on the heart – this is how, our patient who successfully recovered and wanted to share her experience at our clinic, started her testimonial.

Following the deterioration of her condition, she was transferred by ambulance to our clinic where the intensive treatment began.

– The condition I was in was difficult and life threatening. I was immediately put on a blood purification machine – venous hemodiafiltration and oxygen support. Only after a few difficult days I felt that the therapy had started to work, and the parameters that had been quite out of the limits began to return to normal, and also the breathing, although still very difficult, started to become easier.

I am deeply grateful to the medical staff for the excellent care they had given me. I am especially grateful to the physiotherapists who, during the stabilization period of my health condition, following the filtration, immediately started with exercises for lung strengthening, gradually loading them to the point where I no longer need oxygen support. This clinic uses the latest and most modern apparatus for treatment of both:  muscles and easier release of the accumulated secretion in the lungs, and the medications and treatment are personalized and planned for each patient individually. I received an excellent care in all aspects of my treatment, and I was under constant control and examination. I was provided with such psychological support by the professional, kind and cheerful doctors and nurses who in those difficult moments gave me the strength to fight for my life. My family was constantly and regularly informed about my health condition, but they were aware of the fact that I was in the best hands not only in our country Macedonia but also in the world. I express my deep and sincere gratitude to Dr. Zan Mitrev not only for his professionalism and commitment to the patients, but also for building this Clinic and employing this exceptionally professional staff with whom he saved thousands of lives, and now they have saved mine.

I thank them once again and wish them to gain as much strength as possible in order to carry on with their dedicated work and to quickly find a strategy for Covid 19 treatment of the seriously ill patients. I believe that one should only follow the thought of God that sent him here to do good to his people. Be careful, do your best in order to reduce the risk of spreading Covid 19 and to protect yourself and your loved ones! I wish you may be in good health! – Sincerely, B.K.  – this is how, our patient ends her testimonial, to whom we wish she may be in good health and happiness in the future.

Today, Doctor Zhan Mitrev visited Ivan Ognjanovski, the patient who underwent the first heart transplant in the country.

Ivan is in good health and according to the recommendations of Doctor Mitrev he is already preparing for discharge from the hospital and further treatment and care in his home.

Ivan was looking forward to the meeting with Dr. Mitrev and therefore he got up on his feet and greeted Droctor Mitrev wishing to assure all present of his desire to recover and return to normal life as soon as possible.

Doctors from our clinic have been continually involved in his recovery from the very beginning, and together with the colleagues from the state cardiac surgery, they monitor his health condition every single minute.

The cooperation between Zan Mitrev Clinic and the state cardiac surgery team continues, especially when it comes to seriously ill patients.

With hemofiltration to a negative Covid-19 test.

Last Saturday late night, a patient in a hemorrhagic shock due to rupture of the abdominal aneurysm was admitted. Patients with such condition do not survive unless they are operated on immediately. Bleeding is resolved by replacing the abdominal aorta with a vascular prosthesis. We also took specimen for Covid-19 test.

By the end of the surgery, the result of the Covid-19 test showed that the patient was positive for Covid-19. Upon admission, he had a fever and cough, which confirmed the finding.

Since the Ministry of Health allows treating of Covid-19 patients only in the centers designated for this purpose, immediately after the surgery we tried to transfer the patient to those centers (the surgery was successful) but we did not succeed because all centers were occupied and could not accept the patient.

We had to continue the treatment and the next day we started the process of continuous blood purification with a special filter, which removes all infective mediators created by any blood infection.

We have been using this method for 8 years and with the experience we had with similar conditions of different causes, we knew that this was the only method we could use to help the patient because we do not have any experience with Covid-19 and this type of condition.

The filtration process usually lasts 48 hours continuously, but only after 12 hours, the filter was completely clogged. This was due to many infective mediators and toxins that were at the time circulating in the blood.

After this blood filtration, the patient recovered well and after two days we made another Covid-19 test, which was negative. The next three tests were also negative. So, after only six days of treatment, the patient was in a good general condition, with negative Covid-19 test and we discharged him.

“This is only one positive experience” – say from the Zan Mitrev Clinic.