[ACTIV SARS-CoV-2 registry (Analysis of Chronic Non-infectious Diseases Dynamics After COVID-19 Infection in Adult Patients). Assessment of impact of combined original comorbid diseases in patients with COVID-19 on the prognosis].

AIM: Study the impact of various combinations of comorbid original diseases in patients infected with COVID-19 later on the disease progression and outcomes of the new coronavirus infection. MATERIALS AND METHODS: The ACTIV registry was created on the Eurasian Association of Therapists initiative. 5,808 patients have been included in the registry: men and women with COVID-19 treated at hospital or at home. CLINICALTRIALS: gov ID NCT04492384. RESULTS: Most patients with COVID-19 have original comorbid diseases (oCDs). Polymorbidity assessed by way of simple counting of oCDs is an independent factor in negative outcomes of COVID-19. Search for most frequent combinations of 2, 3 and 4 oCDs has revealed absolute domination of cardiovascular diseases (all possible variants). The most unfavorable combination of 2 oCDs includes atrial hypertension (AH) and chronic heart failure (CHF). The most unfavorable combination of 3 oCDs includes AH, coronary heart disease (CHD) and CHF; the worst combination of 4 oCDs includes AH, CHD, CHF and diabetes mellitus. Such combinations increased the risk of lethal outcomes 3.963, 4.082 and 4.215 times respectively. CONCLUSION: Polymorbidity determined by way of simple counting of diseases may be estimated as a factor in the lethal outcome risk in the acute phase of COVID-19 in real practice. Most frequent combinations of 2, 3 and 4 diseases in patients with COVID-19 primarily include cardiovascular diseases (AH, CHD and CHF), diabetes mellitus and obesity. Combinations of such diseases increase the COVID-19 lethal outcome risk.

Analysis of influence of background therapy for comorbidities in the period before infection on the risk of the lethal COVID outcome. Data from the international ACTIV SARS-CoV-2 registry («Analysis of chronic non-infectious diseases dynamics after COVID-19 infection in adult patients SARS-CoV-2¼).

Aim      To study the effect of regular drug therapy for cardiovascular and other diseases preceding the COVID-19 infection on severity and outcome of COVID-19 based on data of the ACTIVE (Analysis of dynamics of Comorbidities in paTIents who surVived SARS-CoV-2 infEction) registry.Material and methods  The ACTIVE registry was created at the initiative of the Eurasian Association of Therapists. The registry includes 5 808 male and female patients diagnosed with COVID-19 treated in a hospital or at home with a due protection of patients' privacy (data of nasal and throat smears; antibody titer; typical CT imaging features). The register territory included 7 countries: the Russian Federation, the Republic of Armenia, the Republic of Belarus, the Republic of Kazakhstan, the Kyrgyz Republic, the Republic of Moldova, and the Republic of Uzbekistan. The registry design: a closed, multicenter registry with two nonoverlapping arms (outpatient arm and in-patient arm). The registry scheduled 6 visits, 3 in-person visits during the acute period and 3 virtual visits (telephone calls) at 3, 6, and 12 mos. Patient enrollment started on June 29, 2020 and was completed on October 29, 2020. The registry completion is scheduled for October 29, 2022. The registry ID: ClinicalTrials.gov: NCT04492384. In this fragment of the study of registry data, the work group analyzed the effect of therapy for comorbidities at baseline on severity and outcomes of the novel coronavirus infection. The study population included only the patients who took their medicines on a regular basis while the comparison population consisted of noncompliant patients (irregular drug intake or not taking drugs at all despite indications for the treatment).Results The analysis of the ACTIVE registry database included 5808 patients. The vast majority of patients with COVID-19 had comorbidities with prevalence of cardiovascular diseases. Medicines used for the treatment of COVID-19 comorbidities influenced the course of the infectious disease in different ways. A lower risk of fatal outcome was associated with the statin treatment in patients with ischemic heart disease (IHD); with angiotensin-converting enzyme inhibitors (ACEI)/angiotensin receptor antagonists and with beta-blockers in patients with IHD, arterial hypertension, chronic heart failure (CHF), and atrial fibrillation; with oral anticoagulants (OAC), primarily direct OAC, clopidogrel/prasugrel/ticagrelor in patients with IHD; with oral antihyperglycemic therapy in patients with type 2 diabetes mellitus (DM); and with long-acting insulins in patients with type 1 DM. A higher risk of fatal outcome was associated with the spironolactone treatment in patients with CHF and with inhaled corticosteroids (iCS) in patients with chronic obstructive pulmonary disease (COPD).Conclusion      In the epoch of COVID-19 pandemic, a lower risk of severe course of the coronavirus infection was observed for patients with chronic noninfectious comorbidities highly compliant with the base treatment of the comorbidity.

[A rare case of oxalate nephropathy with acute renal injury].

Objective: This case demonstrates the difficulty of diagnostics of oxalate nephropathy and possibility of development of acute kidney injury. Summary: The paper describes a patient with oxalate nephropathy and acute kidney injury. Specific features of oxalate diathesis are discussed as well as approaches to its diagnosis. Clinical peculiarities and diagnostic difficulties are described. Conclusions: Early diagnosis of oxalate nephropathy and treatment permits to improve prognosis.

[Anemia and gastrointestinal tract diseases].

The paper considers the causes of iron- and cyanobalamin-deficiency anemias caused by gastrointestinal tract (GT) diseases, among which malabsorption along with loss of these nutrients through the GT is of great importance. The paper reflects the current views of the pathogenesis of deficiency anemias that develop in gluten-sensitive celiac disease and atrophic gastritis. Among the atrophic gastritides, there are two forms caused by autoimmune processes and long-term Helicobacter pylori persistence, whose treatment is an effective measure in refractory anemia. The paper gives the provisions of the Russian Gastroenterology Association Guidelines (2012) for the management of H. pylori infection, which are based on Maastricht IV consensus (2010).

[Psychosomatic relationships in postmenopausal women].

AIM: To study the prevalence of depressive and anxiety disorders in postmenopausal disorders and their relationship with the manifestations of climacteric syndrome. SUBJECTS AND METHODS: The study enrolled 203 women, including 142 patients with surgical menopause and 61 with natural menopause. Psychometric testing using the Hamilton depression rating scale and the Spielberger test anxiety inventory, and 24-hour blood pressure (BP) monitoring with assessment of the 24-hour BP profile were performed. RESULTS: Depressive disorders (DD) were found in 82.5% of the postmenopausal women; all the patients had higher levels of situational and personality anxiety. The women with natural menopause developed moderate and severe DD and those who had undergone ovariectomy had mild DD. The prevalence of DD was higher in patients with essential hypertension (EH) than in those with normal BP (88.6 and 78.3%, respectively; p < 0.01); DD was more marked in these patients. The severity of DD also depended on the type of diurnal BP variations; the highest level of depression was recorded in patients without nocturnal BP reduction. The same group was found to have the highest level of personality and situational anxiety. CONCLUSION: The magnitude of DD depends on the type of menopause, the presence of EH, and the specific features of diurnal BP variations. The findings necessitate a detail examination of postmenopausal women for identification of affective disorders and their further correction.

[Antibiotic-associated diarrhea in clinical practice].

Antibiotic-associated diarrhea (AAD) is considered to mean at least 3 shapeless stool episodes within 2 or more consecutive days when using antibacterial agents. Due to the fact that antibiotics are used most commonly to treat many diseases, AAD is one of the topical problems for different clinical specialists. There has recently been increased interest in this condition due to its higher morbidity and mortality rates and the emergence of novel treatment-resistant virulent strains of Clostridium difficile 027 and 078/126. The paper discusses the possible risk of developing AAD depending on the class of the antibiotic used, as well as the mechanisms of its development. Infectious diarrhea most frequently results from bacterial overgrowth due to that the obligate intestinal microflora is suppressed by antibacterial drugs. C. difficile, Clostridium perfringers, Staphylococcus aureus, Salmonella spp., Klebsiella oxytoca, and Candida spp. are etiological factors in the development of this diarrhea. The severest intestinal lesions include pseudomembranous colitis (PMC) caused by C. difficile. The clinical and endoscopic picture and methods for the diagnosis and treatment of PMC are described. Therapy for this menacing condition is traditionally based on the use of metronidazole and vancomycin. In 2011, the US Food and Drug Administration approved the new drug fidaxomycin whose superiority over vancomycin has been demonstrated by a recurrence criterion. The paper discusses in detail other treatment options, including the use of probiotics.

[The role of imbalance of fatty acids in formation of endothelium dysfunction in women in menopause].

The article deals with the results of examination of 203 women in condition of natural (61 female patients) and surgical (142 female patients) post menopause. The rate of occurrence of impairment of functional state of endothelium made up to 67% (136 of examined female patients). The nitroxide-producing function of endothelium was decreased in all female patients, most of all in women with surgical menopause. The patients with endothelium dysfunction symptoms had a significant decrease of amount of omega-3 polyunsaturated fatty and arachidonic acids in erythrocytes' membranes and an increase of amount of gamma-linolenic and dihomo-gamma-linolenic acids. The multidirectional correlation dependences between indicators of endothelium function and amount of various fatty acids in erythrocytes' membranes was established.

[Causes, complications and risk factors of severe influenza A (H1N1)].

Analysis of 35 deaths from A(H1N1) influenza virus infection in the Transbaikal region (autumn 2009) is reported. All the cases were under 60 years of age. Viral/bacterial pneumonia complicated by acute respiratory distress syndrome (ARDS) was the main cause of fatal outcomes. Enteroccocci were found in 83.3% of the seeded autopsy samples. Possible enterococcal infection pathways and mechanisms of ARDS development are discussed. The role of heat shock proteins is postulated. Disturbances of lipid metabolism are supposed to be major risk factors of severe influenza and its fatal outcome that may be related to obesity through common pathogenetic pathways.

[The fatty acid composition of plasma lipids in postmenopausal women].

Two hundred and three postmenopausal females were examined. Pronounced changes were established to occur in the fatty acid composition of plasma lipids with elevated levels of saturated and monounsaturated fatty acids, reduced content of linoleate and alpha-linolenoate, and a significant increase in the concentrations of arachidonic and dihomo-gamma-linolenic acids. The content of individual fatty acids was found to vary with the type (natural or surgical) of menopause and to be also associated with the major parameters of 24-hour blood pressure profile and intracardiac hemodynamics.