[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.

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.

[THE CENTURY OF WAGNER PERM STATE MEDICAL UNIVERSITY].

Perm City is the large industrial, scientific, educational and cultural center in Volga Federal District. Also it is one of the oldest and the most attractive Ural cities. Higher medical education on the West Ural was founded in 1916. The main stages of the development of Perm State Medical University are lightened in the article. Perm State Medical University is the peculiar school of experts of different medical specialties, scientific and educational personnel, specialists of the middle range of the health care system. The history of the university is full of historical, professional and creative traditions. 2016 year is the century of the higher medical education on the West Ural and the anniversary year for Perm State Medical University by E.A. Wagner.

[SYSTEMIC INFLAMMATION MARKERS AND MICROALBUMINURIA IN INFLAMMATORY BOWEL DISEASES].

PURPOSE: The aim of the investigation was to study the characteristics of endothelial function in patients with IBD. MATERIALS AND METHODS: 61 patients with ulcerative colitis (UC) and Crohn's disease (CD) in the acute phase or with newly diagnosed forms of the disease were examined. CD group included 16 people (8 women and 8 men) mean age 35.63 ± 5.51 years. UC group included 45 patients (18 women and 27 men), their average age was 36.76 ± 3.17 years. To assess the endothelial dysfunction the level of microalbuminuria (MAU) was examined with Micral-Test strips. Serum concentration levels of CRP, TNF--α, alpha1 and alpha 2-globulins, fibrinogen as well as ESR were evaluated as the markers of systemic inflammation. RESULTS: In CD patients a significant increase of MAU in severe forms of the disease 32 ± 10.95 mg/I (p < 0.05). was revealed. Furthermore, MAU was significantly higher in individuals with extraintestinal manifestations and complications of CD (28.01 ± 17.89 mg/I and 20.00 ± 14.14 mg/, respectively). A significant relationship of the MAU levels and severity of CD (r = 0.797, p = 0.0002) as well as the presence of extraintestinal symptoms (r = 0.625, p = 0.0096) were identified. The evaluation of the systemic inflammation narkers showed a significant increase of CRP levels and ESR in severe forms of IBD. A positive correlation of CD with the ESR (r = 0.802, p = 0.0021), CRP (r = 0.773, p = 0.0004), alpha-2 globulin (r = 0.534, p = 0.0298) and fibrinogen (r = 0.647, p = 0.0067) was identified. CONCLUSIONS: The evidence of endothelial dysfunction in patients with IBD was revealed that was expressed in the MAU levels elevation. The MAU level can be regarded as the criterion of the CD severity as well as the sign of its unfavorable course.

CLINICAL AND EPIDEMIOLOGICAL PECULIARITIES IBD IN THE PERM KRAI.

Purpose of the study - to study the clinical and epidemiological features of IBD according to the register in the Perm region. Materials and methods, It analyzed 411 case histories of patients with IBD. In each patient itwas wound profile, details of which laid the foundation for a regional register. RESULTS: Created register of patients with IBD. The data we have created registers allow clinically characterized patients with Crohn's disease and ulcerative colitis in the Perm Krai.

[LEFT VENTRICULAR MYOCARDIAL REMODELING IN PATIENTS WITH ARTERIAL HYPERTENSION ASSOCIATED WITH ACID-DEPENDENT DISEASES].

Comorbid pathologies remain a serious challenge for researchers and practitioners. According to different authors, from 11.6 to 50% therapeutic patients suffer arterial hypertension (AH) concomitant with acid-dependent diseases (ADD). Peculiarities of such combination are poorly known. The aim of this work was to evaluate the structural and functional status of left ventricular (LV) myocardium in patients with AH and ADD. It included 127 patients of mean age 42.44:2.78 years. Control group consisted of 25 age-matched patients with isolated AH. The ultrasound study of structural and functional parameters of LV myocardium was followed by the analysis of various types of its remodeling. It was shown that patients with isolated AH are characterized by significantly higher structural and functional parameters of LV myocardium remodeling compared with the patients having AH and concomitant ADD. It suggests a specific type of remodeling in the former group that can be used as a predictor of higher cardiovascular risk in these patients.

[Complex evaluation of intestine microbiocenosis condition in patients with chronic pancreatitis].

AIM: Study the state of intestine microbiocenosis in patients with chronic pancreatitis, give comparative evaluation of diagnostic significance of bacterial and gas-liquid chromatography analysis. MATERIALS AND METHODS: 96 patients with chronic pancreatitis (CP) were examined bacteriologically for dysbacteriosis. In parallel in 42 individuals gas-liquid chromatography analysis (GLC-analysis) was carried out. RESULTS: During bacteriological examination in 93.7% of patients various dysbiotic disorders were detected. The main indicators of GLC-analysis---anaerobic index, cumulative content of volatile fatty acids and their isoforms also gave evidence on imbalance of intestine microflora. GLC-analysis as a rule confirmed the data of bacteriological examination. CONCLUSION: During parallel use ofbacteriological and gas-liquid chromatography analysis in almost all the CP patients intestine dysbacteriosis of various degree of intensity was detected. Combined use of these methods increases effectiveness of examination.

[Problem of a comorbidity of arterial hypertension and acid-dependent diseases].

The paper presents a concise literature review on the concomitant course of the most common nosological entities in the population, such as arterial hypertension (AH) and acid-dependent diseases (ADD). Data on the prevalence, commonness of etiological and pathogenetic factors, the specific features of a clinical course, and diagnostic difficulties are analyzed in persons with AH associated with ulcerative and gastrointestinal reflux diseases. The causes and consequences of these nosological entities are shown; their clinical, morphological, and hemodynamic features are covered. The results of investigations characterizing the specific features of autonomic regulation, diurnal blood pressure variations, and the central hemodynamics in the comorbidity of the diseases in question are given. The rational antihypertensive therapy of AH concurrent with ADD is presented in terms of their impact on gastrointestinal tract disease.

[The prediction of atrial fibrillation in patients with arterial hypertension].

AIM: To study the parameters of the structural and functional state of the myocardium in patients with hypertension, to determine their prognostic value on the risk of atrial fibrillation (AF). PATIENTS AND METHODS: The study involved 72 people: patients with hypertension and AF, with isolated hypertension and apparently healthy individuals. All of them performed echocardiography, blood pressure monitoring and monitoring of cardiogram. RESULTS: The dilatation of left atrial was founded: patients with the atrial fibrillation on the background of hypertension observed the most pronounced changes in the left atrial. In patients with hypertension without arrhythmias and in combination with atrial fibrillation severe left ventricular hypertrophy was observed. Left ventricle systolic function in groups has been stored but in patients with atrial fibrillation on the background of hypertension was significantly lower. The risk of atrial fibrillation in patients with hypertension prognostic value are the only values of the age, the volume index of the left atrial to the body surface area and left ventricular ejection fraction. CONCLUSIONS: The risk of AF in hypertension occurs over the age of 55 and each subsequent year increases it in 1,2 times, it increases with an index value of the left atrial to the body surface over 29 ml/m2 and with a decrease in left ventricular ejection fraction less than 58%.

[Possibility of predicting the use of doxazosin in the treatment of arterial hypertension]. / Vozmozhnost' prognozirovaniia ispol'zovaniia doksazozina v lechenii arterial'noi gipertenzii.

Fifteen patients with arterial hypertension (AH) were examined. Their peripheral venous hemodynamics, central circulation, systolic and diastolic functions were studied and a course therapy with doxazosin (cardura, Pfizer, USA) was performed for 30 days. Cardura (doxazosin) was found to be the drug of choice for antihypertensive therapy in patients with AH concurrent with baseline systemic venous normo- or hypertension. In patients with baseline venous hypervolemia in the presence of venous hypotension, cardura therapy resulted in deterioration of signs of venous insufficiency and promoted the development (in 38% of the cases) or progression (in 38%) of diastolic dysfunction of the left ventricle (LV). Thus, the venous circulation and LV myocardial function should be originally assessed in order to decide whether cardura (doxazosin) is used in antihypertensive therapy in patients with AH.

[Venous dysfunction in patients with hypertension and different hemodynamic variants of disease]. / Varianty venoznoi disfunktsii u bol'nykh gipertonicheskoi bolezn'iu s razlichnymi gemodinamicheskimi variantami zabolevaniia.

AIM: To identify variants of venous dysfunction in patients with arterial hypertension (AH) in respect of the disease hemodynamic profile. MATERIAL AND METHODS: The assessment of central hemodynamics and peripheral venous circulation in the veins of the lower limbs was made in 60 patients with different hemodynamic variants of primary AH. RESULTS: Patients with ejection hypertension were characterized by high extensibility of the peripheral veins and low tolerance to orthostatic loads. In patients with hypertension of resistance venous dysfunction was characterized by signs of venous hypertension in rigidity of the venous wall as well as low and inadequate reactivity of peripheral large vessels. CONCLUSION: The results of the orthostatic test show different response of venous hemodynamics in patients with hypertension of ejection and resistance. This provides adequate activity of the heart in erect position.