[The impact of BMI on the course of the acute SARS-COV-2 infection and the risks that emerge during the first year after the hospital discharge. Subanalysis evidence of the AKTIV and AKTIV 2 registries].

BACKGROUND: There is enough evidence of the negative impact of excess weight on the formation and progression of res piratory pathology. Given the continuing SARS-CoV-2 pandemic, it is relevant to determine the relationship between body mass index (BMI) and the clinical features of the novel coronavirus infection (NCI). AIM: To study the effect of BMI on the course of the acute SARS-COV-2 infection and the post-covid period. MATERIALS AND METHODS: AKTIV and AKTIV 2 are multicenter non-interventional real-world registers. The АКТИВ registry (n=6396) includes non-overlapping outpatient and inpatient arms with 6 visits in each. The АКТИВ 2 registry (n=2968) collected  the  data  of  hospitalized  patients  and  included  3  visits.  All  subjects  were  divided  into  3  groups:  not  overweight  (n=2139), overweight (n=2931) and obese (n=2666). RESULTS: A higher BMI was significantly associated with a more severe course of the infection in the form of acute kidney injury (p=0.018), cytokine storm (p<0.001), serum C-reactive protein over 100 mg/l (p<0.001), and the need for targeted therapy (p<0.001) in the hospitalized patients. Obesity increased the odds of myocarditis by 1,84 times (95% confidence interval [CI]: 1,13-3,00) and the need for anticytokine therapy by 1,7 times (95% CI: 1,30-2,30).The  patients  with  the  1st  and  2nd  degree  obesity,  undergoing  the  inpatient  treatment,  tended  to  have  a  higher  probability  of  a  mortality  rate.  While  in  case  of  morbid  obesity  patients  this  tendency  is  the  most  significant  (odds  ratio  -  1,78; 95% CI: 1,13-2,70). At the same time, the patients whose chronical diseases first appeared after the convalescence period, and those who had certain complaints missing before SARS-CoV-2 infection, more often had BMI of more than 30 kg/m2 (p<0,001).Additionally, the odds of death increased by 2,23 times (95% CI: 1,05-4,72) within 3 months after recovery in obese people over the age of 60 yearsCONCLUSION.  Overweight  and/or  obesity  is  a  significant  risk  factor  for severe  course  of  the  new  coronavirus  infection  and  the associated cardiovascular and kidney damage Overweight people and patients with the 1st and 2nd degree obesity tend to have a high risk of death of SARS-CoV-2 infection in both acute and post-covid periods. On top of that, in case of morbid obesity patients this tendency is statistically significant. Normalization of body weight is a strategic objective of modern medicine and can contribute to prevention of respiratory conditions, severe course and complications of the new coronavirus infection.

[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.

[The association of serum folate levels with schizophrenia symptoms]. / Assotsiatsiya urovnya folatov syvorotki krovi s klinicheskimi simptomami shizofrenii.

OBJECTIVE: To evaluate the association of serum folate levels with schizophrenia and its clinical characteristics in patients from a Russian sample. MATERIAL AND METHODS: Ninety-three patients with schizophrenia and 60 healthy volunteers were examined. Determination of serum folate levels was performed by chemiluminescent immunoassay on microparticles (Architect, Abbott Lab SA). Symptoms of schizophrenia were assessed with the Positive and Negative Syndrome Scale, the Calgary Schizophrenia Depression Scale, the Snight-Hamilton Anhedonia Scale, the Brief Assessment of Cognition in Schizophrenia, the Personal and Social Performance Scale, the Scale for Therapy Side-Effects assessment, Simpson-Angus scales, abnormal involuntary movements scale, Barnes akathisia rating scale. Statistical analysis was performed using the Statistica 6.0. Since the data distribution was different from normal, non-parametric criteria were used. RESULTS: Patients had significantly lower folate levels than healthy controls (p=0.00053), mainly in women (p=0.0025). At the same time, in all the subgroups (including healthy ones), the vast majority of the participants had folate levels below the median (9.95 ng/ml) and in the lower quartile of the reference values. In patients, folate levels are inversely correlated with the severity of most negative symptoms and directly correlated with all measures of cognitive functions. Patients with folate levels below the reference values differed from other patients by a greater severity of the total score of negative symptoms (p=0.023), Marder's factors of negative symptoms (p=0.046) and disorganized thinking (p=0.033), a greater severity of general side effects of therapy (p=0.021) and all measures of cognitive functions except for verbal memory. Smoking has a significant effect on serum folate levels in all participants (p=0.016). There was also an inverse association of folate levels with the selectivity of antipsychotics (p=0.035), and more severe folate deficiency in inpatients than outpatients (p=0.0063). CONCLUSION: The results obtained in the Russian sample on the association of folate deficiency with schizophrenia and a wide range of clinical indicators, including those affecting the prognosis of schizophrenia, indicate the high relevance of further study of this topic and the introduction of approaches to augmentation of antipsychotic therapy for schizophrenia with folates.

Genome Features of Probiotic Bifidobacteria Determining Their Strain-Specific Properties.

The aim of the study was to analyze the genome features of the probiotic strains Bifidobacterium longum 379, Bifidobacterium bifidum 1, and Bifidobacterium bifidum 791 and study their antiviral activity. Materials and Methods: Whole genome sequencing of three strains of bifidobacteria was performed on the MiSeq platform (Illumina Inc., USA). The genomes were annotated using the Prokka v. 1.11 utility and RAST genomic server. The individual genetic determinants were searched using the ResFinder 3.2, PathogenFinder, PlasmidFinder, RAST, and Bagel 4 software. The antiviral activity of the strains against influenza A viruses was studied using MDCK cells (Madin-Darby canine kidney cells), the epidemic strain of influenza A/Lipetsk/1V/2018 (H1N1 pdm09) (EPI_ISL_332798), the highly pathogenic avian influenza virus A/common gull/Saratov/1676/2018 (H5N6) strain (EPI_ISL_336925), and neutral red vital dye. Results: The genomes of all studied strains contained determinants responsible for utilization of carbohydrates of plant origin; the genes of key enzymes for the synthesis of tryptophan and folic acid are present in the genomes of B. longum 379 and B. bifidum 791. A feature of the B. bifidum 791 genome is the presence of determinants responsible for the synthesis of thermostable type I bacteriocins - flavucin and lasso peptide. The B. bifidum 791 strain was found to show pronounced antiviral activity against both the strains of influenza A, the supernatant of which suppressed viral replication in vitro up to a dilution of 1:8, and the cells inhibited viral reproduction up to a concentration of 6·106 CFU/ml. Conclusion: The analysis of complete genomes of B. longum 379, B. bifidum 1, and B. bifidum 791 showed features that determine their strain-specific properties, the findings on which were previously made empirically based on indirect signs. In the genomes of B. longum 379 and B. bifidum 791 strains, in contrast to B. bifidum 1 strain, key enzymes for the synthesis of tryptophan and folic acid were found. These substances have an impact on the human body in many ways, including having a thymoleptic effect (reducing emotional stress, irritability, anxiety, eliminating lethargy, apathy, melancholy, anxiety) and regulating cognitive activity. The presence of determinants responsible for the synthesis of thermostable type I bacteriocins in the genome of B. bifidum 791 strain determines its pronounced antiviral activity.

Modernization of Regression Models to Predict the Number of Deaths from the New Coronavirus Infection.

The aim of the study was to modernize the existing prognostic regression models in the context of expanding knowledge about the new coronavirus infection. Materials and Methods: The modification of models and the increase in their predictive ability are based on collecting the available data from international and Russian databases. We calculated the traditional descriptive statistics and used the linear regression analysis for modeling. The work was performed using the IBM SPSS Statistics 26.0 and the R 3.6.0 (RStudio) software. Results: Manifestations of the COVID-19 epidemic process in several countries were studied; special attention was put to the number of deaths associated with the infection. A significant proportion of severe cases were noted among patients both in Russia and elsewhere. Considering that the disease incidence has reached its peak in China and Italy, we were able to improve the previously published (Sovremennye tehnologii v medicine 2020, Vol. 12, No.2) regression models and to compare their performance. The first modified model is based on the absolute increase in new cases of the infection: its regression coefficient is 0.16 (95% CI 0.137-0.181). In the extended version of the updated model, we additionally considered cases of aggravated COVID-19: the regression coefficients were 0.128 (95% CI 0.103-0.153) for model 2 and 0.053 (95% CI 0.029-0.077) for model 1.1; p=0.0001. Conclusion: Based on the most recent data (from January to May 2020) on the incidence of COVID-19 in the world, we have developed more specific versions of the basic and extended regression models of lethal outcomes. The resulting models are optimized and extrapolated to the current epidemiological situation; they will allow us to improve our analytical approach. For that purpose, data collection is currently ongoing.

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.

Homocysteine in Schizophrenia: Independent Pathogenetic Factor with Prooxidant Activity or Integral Marker of Other Biochemical Disturbances?

A wide range of studies have demonstrated that hyperhomocysteinemia is associated with the risk of schizophrenia, but currently available assumptions about the direct involvement of homocysteine (Hcy) in the pathogenesis of schizophrenia are hypothetical. It is possible that in vivo Hcy is only a marker of folate metabolism disturbances (which are involved in methylation processes) and is not a pathogenetic factor per se. Only one study has been conducted in which associations of hyperhomocysteinemia with oxidative stress in schizophrenia (oxidative damage to protein and lipids) have been found, and it has been suggested that the oxidative stress may be induced by the elevated Hcy in schizophrenic patients. But the authors did not study the level of reduced glutathione (GSH), as well as possible causes of hyperhomocysteinemia-disturbances of folate metabolism. The aim of this work is to analyze the association of Hcy levels with the following: (1) redox markers in schizophrenia GSH, markers of oxidative damage of proteins and lipids, and the activity of antioxidant enzymes in blood serum; (2) with the level of folate and cobalamin (В12); and (3) with clinical features of schizophrenia measured using the Positive and Negative Syndrome Scale (PANSS). 50 patients with schizophrenia and 36 healthy volunteers, matched by sex and age, were examined. Hcy in patients is higher than in healthy subjects (p = 0.0041), and this may be due to the lower folate level in patients (p = 0.0072). In patients, negative correlation was found between the level of Hcy both with the level of folate (ρ = -0.38, p = 0.0063) and with the level of B12 (ρ = -0.36, p = 0.0082). At the same time, patients showed higher levels of oxidative modification of serum proteins (p = 0.00046) and lower catalase (CAT) activity (p = 0.014). However, Hcy is not associated with the studied markers of oxidative stress in patients. In the group of patients with an increased level of Hcy (>10 µmol/l, n = 42) compared with other patients (n = 8), some negative symptoms (PANSS) were statistically significantly more pronounced: difficulty in abstract thinking (N5, p = 0.019), lack of spontaneity and flow in conversation (N6, p = 0.022), stereotyped thinking (N7, p = 0.013), and motor retardation (G7, p = 0.050). Thus, in patients with schizophrenia, hyperhomocysteinemia caused by deficiency of folate and B12 is confirmed and can be considered a marker of disturbances of vitamin metabolism. The redox imbalance is probably not directly related to hyperhomocysteinemia and is hypothetically caused by other pathological processes or by an indirect effect of Hcy, for example, on the enzymatic antioxidant defence system (CAT activity), which requires further exploration. Further study of the role of Hcy in the pathogenesis of schizophrenia is relevant, since the proportion of patients with hyperhomocysteinemia is high and correlations of its level with negative symptoms of schizophrenia are noted.

[International register "Analysis of Chronic Non-infectious Diseases Dynamics After COVID-19 Infection in Adult Patients (ACTIV SARS-CoV-2)"].

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[The double-blind randomized placebo-controlled trial of N-acetylcysteine use in schizophrenia: preliminary results]. / Dvoinoe slepoe randomizirovannoe platsebo-kontroliruemoe issledovanie primeneniya N-atsetiltsisteina pri shizofrenii: predvaritel'nye rezul'taty.

BACKGROUND: Currently, oxidative stress as part of the pathogenesis of schizophrenia attracts much attention. In this regard, it becomes relevant to assess the level of redox imbalance in patients with schizophrenia, its impact on existing symptoms and the possibility of its treatment. The antioxidant N-acetylcysteine is one of the potential drugs that affects oxidative stress. OBJECTIVE: To study the possibilities of the use of N-acetylcysteine in patients with schizophrenia. MATERIAL AND METHODS: The study included 20 patients diagnosed with paranoid schizophrenia with the disease duration of less than 3 years, randomly assigned to the main group (taking N-acetylcysteine at a dose of 2000 mg per day for 60 days) and a comparison group (placebo) in a double-blinded manner. At the beginning and end of the study, cognitive functions were evaluated using the specialized instrument BACS, the severity of psychopathological symptoms was evaluated using PANSS, and blood was collected to determine the level of glutathione (GSH), which is a metabolite of N-acetylcysteine. RESULTS: There was a significant decrease in positive PANSS score (p=0.013), negative PANSS score (p=0.002) and the general pathology PANSS score (p=0.004) in the main group. Compared with the comparison group, the dynamics of the negative PANSS score (p=0.005) and the general psychopathology PANSS score (p=0.004) was significantly different. When assessing the dynamics of cognitive functions in the main group, a significant improvement in indicators was established in the task for a sequence of numbers that characterizes working memory (p=0.037). The level of GSH significantly increased in the main group (p=0.01), however, there were no statistically significant differences between groups at the final visit. CONCLUSION: N-acetylcysteine has a positive effect on the negative, general psychopathology PANSS scores, some cognitive functions, in particular, working memory, that allows considering this drug as a promising method of augmentation of schizophrenia therapy and requires further attentive study.

[The effect of various forms of folates on cognitive functions in patients with chronic schizophrenia]. / Vliyanie raznykh form folatov na kognitivnye funktsii u bol'nykh khronicheskoi shizofreniei.

OBJECTIVE: To assess the dynamics of cognitive functions in patients with schizophrenia during intake of various forms of folate as an add-on to antipsychotic therapy. MATERIAL AND METHODS: Using a battery of cognitive tests, the authors evaluated the dynamics of cognitive functions in 3 groups of patients with schizophrenia who received folic acid (n=25), metafolin (n=25) during 4 weeks and in the control group (n=25). Genetic variants of the polymorphism of the folate metabolism enzyme methylenetetrahydrofolate reductase (MTHFR) 677C>T were determined using real-time PCR. Only the carriers of the minor T allele were included in the study. RESULTS AND CONCLUSION: The improvement of certain cognitive functions was noted after folate administration, it was more pronounced and statistically significant in the metapholin group. The results hold promises for further studies of prolonged use of folate in prophylactic doses for schizophrenia.

Regression Models Predicting the Number of Deaths from the New Coronavirus Infection.

Predicting the development of epidemic infection caused by the COVID-19 coronavirus is a matter of the utmost urgency for health care and effective anti-epidemic measures. Given the rapidly changing initial information and the ambiguous quality of data coming from various sources, it is important to quickly optimize the existing prognostic models by using more sophisticated algorithms. The aim of the study is to test the originally developed mathematical algorithms for predicting the development of the COVID-19 epidemic process. MATERIALS AND METHODS: To assess the situation in China, Italy, and the USA, we used the information from Russian- and English-language sources available in official websites. The generally accepted descriptive statistics were used; mathematical modeling was based on linear regression. Statistical data processing was performed using the IBM SPSS Statistics 24.0 and R (RStudio) 3.6.0. RESULTS: We found significant differences not only in the incidence rate of COVID-19 in the countries in question, but also in the death rate. The risk of death associated with COVID-19 is high due to the high number of severe clinical cases of the disease reported from these countries.Two preliminary regression models were created. The first, initial model was based on the increase in new cases of infection - this factor was significantly associated with the outcome; the regression coefficient was 0.02 (95% CI 0.01-0.03). In the second, expanded model, in addition to the increase in new cases, the increase in the number of severe forms of infection was also considered; the regression coefficients were 0.017 (95% CI 0.012-0.022) and 0.01 (95% CI 0.008-0.011), respectively. Adding the second variable contributed to a more accurate description of the available data by the model. CONCLUSION: The developed regression models for infection control and predicting the number of lethal outcomes can be successfully used under conditions of spreading diseases from the group of "new infections" when primary data received from various sourced are changing rapidly and updates of the information are continually required. In addition, our initial model can produce a preliminary assessment of the situation, and the expanded model can increase the accuracy and improve the analytic algorithm.

Association study of methylenetetrahydrofolate reductase genetic polymorphism 677C>T with schizophrenia in hospitalized patients in population of European Russia.

The purpose of the research was to investigate the association of methylenetetrahydrofolate reductase (hereinafter MTHFR) genetic polymorphism 677C>T with schizophrenia in the Russian population in comparison with the control group of healthy blood donors. Also some characteristics of schizophrenia were examined in patients with/without defective T-allele of MTHFR677C>T polymorphism. 500 patients with schizophrenia and 499 blood donors were examined for T-allele carriage of polymorphism MTHFR677C>T by PCR method. 150 archival medical records were studied (in the first patients included in the study). The carriage of T-allele of genetic polymorphism MTHFR677C>T was significantly more common in patients than in healthy donors: 255/500 versus 219/499 (p=0,0287, χ2=4,79; OR=1,33, 95%CI [1037; 1707]). The number of patients with chronic type of schizophrenia onset was significantly more among T-allele carriers (n=77) than among normal CC-genotype carriers (n=73): р=0.038. The number of "incapacitated" persons in the group of patients with defective T-allele (n=77) was significantly higher than in patients with normal genotype (n=73, p=0.0439; OR=2.878, 95%CI=1.111-7.456). The results suggest that T-allele of genetic polymorphism MTHFR677C>T in the population of European Russia may increase the risk of developing schizophrenia and its unfavorable prognosis, which requires further investigation.

[Psychopathological characteristics and social functioning of the schizophrenic patients with the T allele of the MTHFR677C>T polymorphism]. / Psikhopatologicheskaya kharakteristika i osobennosti sotsial'nogo funktsionirovaniya bol'nykh shizofreniei s nositel'stvom T-allelya v polimorfnom lokuse gena obmena folatov MTHFR677C>T.

AIM: To compare the severity of psychopathological symptoms and characteristics of personal and social functioning in patients with schizophrenia, carriers of different alleles of the MTHFR677C>T polymorphism. MATERIAL AND METHODS: One hundred and fifty patients diagnosed with schizophrenia were genotyped for the MTHFR677C>T polymorphism, some of them were examined using psychometric scales and tests (PANSS, SANS, PSP, CDSS, a battery of cognitive tests etc). RESULTS AND CONCLUSION: Patients with the MTHFR677T variant had greater severity of negative symptoms regardless of psychometric instruments used in the study, greater severity of schizophrenia disorder in whole measured with the PANSS General psychopathological symptoms subscale, higher scores on the PANSS cognitive cluster and lower levels of personal and social functioning measured with the PSP compared to the patients with the MTHFR677CС genotype. The results of psychometric testing are in line with significant differences of MTHFR677T allele carriers from those with the MTHFR677CС genotype in the number of disable patients and the use of different types of psychiatric services. The differences were not related to sex, age, illness duration and depressive symptoms measured with CDSS and PANSS «depression/anxiety¼ factor.

[The mode of detection of microorganisms' sensitivity to disinfectants].

The article presents the technique to evaluate the sensitivity of microorganisms-causative agents of infections isolated from patients, carriers and environment to the disinfectants. The proposed technique gives a possibility to detect the condition of microorganism resistance to disinfectant and to evaluate the degree of its sensitivity. The evaluation of sensitivity specificity accuracy, positive and negative prognostic value, reproducibility of developed technique was made.

[Terminologic aspects of infections associated with administration of medical aid].

Evolution of key terms used in epidemiology of nosocomial infections is discussed. A modern point of view on terminology and comparison of Russian terms with foreign analogues are presented.

[Contamination of health care institutions environmental objects by Legionella pneumophila].

UNLABELLED: AIM. The extent of environmental objects contamination by Legionella pneumophila in Nizhny Novgorod and Nizhny Novgorod region hospitals evaluation, and detection of potentially hazardous objects. MATERIALS AND METHODS: 433 swabs of environmental objects, and 43 hot water supply and pool water samples from various departments of 4 multi-disciplinary hospitals were studies. DNA from environmental samples was detected by using real time PCR. RESULTS: L. pneumophila DNA was detected in 41 (9,47%) samples from environmental objects and in 2 (4,65%) samples from hot water supply. These bacteria were more frequently detected in environmental samples from physiotherapy departments. Repeated detection of legionellae from the same objects was registered. CONCLUSION: Circulation of legionellae in multidisciplinary hospitals was determined. Circulation high risk departments and risk objects--reservoirs of L. pneumophila in health care institutions were determined.