[Our experience in the treatment of congenital nasal median heterotopias in children and an overview of various treatment tactics]. / Nash opyt lecheniya vrozhdennykh nazal'nykh sredinnykh geterotopii u detei i obzor taktik lecheniya.

Dermoid nasal cysts (congenital nasal median heterotopias) are a rare congenital pathology in children. OBJECTIVE: Yo consider the clinical picture, methods of radiation diagnosis and to study the surgical results of a dermoid cyst of the nose according to the literature. MATERIALS AND METHODS: A retrospective review of medical histories with the diagnosis of "Dermoid cyst of the back of the nose and nasal cavity, epidermal cyst of the back of the nose, glioma, encephalocele" was conducted from 2017 to 2022 in the Pediatric Otorhinolaryngological Department of the National Medical Research Center for Otorhinolaryngology of the Federal Medical-Biological Agency of Russia. The case histories were analyzed by the nature of the lesion, the imaging techniques performed, the course of the operation and the results obtained. MATERIAL AND METHODS: A total of 16 medical histories were analyzed, the average age was 4.5 years (range 10 months - 15 years), over the past 5 years with a diagnosis of "Dermoid cyst of the nasal dorsum and nasal cavity, glioma, epidermal cyst of the nasal dorsum, encephalocele". All patients underwent magnetic resonance imaging (MRI) in the preoperative period, 14 patients also underwent computed tomography (CT). RESULT: Of these, 7 had a confirmed dermoid cyst with a fistula, 3 patients without a fistula, 3 patients had glioma, and 1 had encephalocele, 2 patients had an epidermoid cyst. A fistulous opening of the dermoid cyst of the nasal dorsum and nasal cavity was observed in the upper third of the nasal dorsum in 3 children, in the middle third in 2 patients and in the lower third in 2 children. The article presents a scheme for the characteristics of the lesion and the tactics of surgical treatment in comparison with the data of foreign authors. Intraoperatively, intracranial spread occurred in 6 patients. Various surgical approaches for intracranial proliferation and a corresponding literature review are also presented. Catamnestic follow-up ranged from 1 to 5 years (on average, 3.5 years), no relapses or postoperative complications were noted. CONCLUSION: Nasal median heterotopias are a rare congenital anomaly. Preoperative preparation should include CT and MRI to assess the lesion and exclude intracranial spread. The surgical approach depended directly on the localization of heterotopia and its spread. All patients had a good cosmetic result after the surgical treatment performed by us according to the author's method.

Trial of labor after cesarean: Maternal and neonatal outcomes from the Consortium on Safe Labor.

BACKGROUND: The aim of our study is to describe maternal and neonatal morbidity and mortality in patients undergoing trial of labor after cesarean from the Consortium on Safe Labor. METHODS: This was a secondary analysis of the Consortium on Safe Labor database, a retrospective cohort study over a 7 year study period. Maternal and neonatal outcomes were evaluated based on desired delivery mode: planned elective repeat cesarean delivery or trial of labor after cesarean. RESULTS: Of 9858 patients in our analysis, our study population had 4400 patients (45%) who desired trial of labor after cesarean and 5458 patients (55%) who desired elective repeat cesarean delivery. Women who attempted trial of labor after cesarean compared to those who had an elective repeat cesarean delivery were more likely to have an obstetric hemorrhage (adjusted odds ratio 1.6; 95% CI 1.3 -2.0) and blood transfusion (adjusted odds ratio 2.3; 95% CI 1.6 -3.2). CONCLUSION: Maternal morbidity in women undergoing trial of labor after cesarean was predominantly hemorrhage-related.

[Identification of Clinical Isolates of the Bacillus cereus Group and Their Characterization by Mass Spectrometry and Electron Microscopy].

Bacillus cereus is a spore-forming bacterium found in the environment mainly in soil. Bacillus spores are known to be extremely resistant not only to environmental factors, but also to various sanitation regimes. This leads to spore contamination of toxin-producing strains in hospital and food equipment and, therefore, poses a great threat to human health. Two clinical isolates identified as B. cereus and B. cytotoxicus were used in the present work. It was shown that their calcium ion content was significantly lower than that of the reference strains. According to electron microscopy, one of the SRCC 19/16 isolates has an enlarged exosporium, and the SRCC 1208 isolate has large electron-dense inclusions of an unclear nature during sporulation. We can assume that these contain a biologically active component with a cytotoxic effect and possibly play a role in pathogenesis. Comparative chemical, biochemical, physiological, and ultrastructural analysis of spores of clinical isolates and reference strains of B. cereus was performed. The results we obtained deepen our understanding of the properties of spores that contribute to the increased pathogenicity of B. cereus group species.

Epidemiology of atrial fibrillation in a representative sample of the European part of the Russian Federation. Analysis of EPOCH-CHF study.

Aim    To study true prevalence of atrial fibrillation (AF) in a representative sample from the European part of the Russian Federation; to describe characteristics of patients with AF; and to provide the frequency of anticoagulant treatment.Material and methods    Cross-sectional data of the EPOCH epidemiological study (2017) were used. Data were collected in 8 constituent entities of the Russian Federation; the sample size was 11 453 people. The sample included all respondents who had given their consent for participation and were older than 10 years. Statistical tests were performed in the R system for statistical data analysis.Results    The prevalence of AF in the representative sample from the European part of the Russian Federation was 2.04 %. The AF prevalence increased with age and reached a maximum value of 9.6% in the age group of 80 to 89 years. The AF prevalence among females was 1.5 times higher than among men. With age standardization, the AF prevalence was 18.95 and 21.33 per 1,000 people for men and women, respectively. The AF prevalence increased in the presence of concurrent cardiovascular diseases (CVDs) or diabetes mellitus as well as with an increased number of comorbidities in the same person and reached 70.3 and 60.0 % in patients with 4 and 5 comorbidities, respectively. Patients with AF had a greater number of comorbidities and higher CHA2DS2VASc scores (5.0 vs. 2.0, p<0.001) compared to patients with CVDs without AF. Only 22.6 % of patients with CVD and AF took anticoagulants. Only 23.9% of patients with absolute indications for the anticoagulant treatment received anticoagulants.Conclusion    The AF prevalence in the European part of the Russian Federation was 2.04 %; it increased with age and in patients with concurrent CVDs or diabetes mellitus. Most of AF patients (93.2 %) required a mandatory treatment with oral anticoagulants.

Chronic heart failure in the Russian Federation: what has changed over 20 years of follow-up? Results of the EPOCH-CHF study.

Aim    To study the etiology and the dynamics of prevalence and mortality of CHF; to evaluate the treatment coverage of such patients in a representative sample of the European part of the Russian Federation for a 20-year period. Material and methods    A representative sample of the European part of the Russian Federation followed up for 2002 through 2017 (n=19 276); a representative sample of the population of the Nizhny Novgorod region examined in 1998 (n=1922).Results    During the observation period since 2002, the incidence of major CHF symptoms (tachycardia, edema, shortness of breath, weakness) tended to decrease while the prevalence of cardiovascular diseases has statistically significantly increased. During the period from 1998 through 2017, the prevalence of I-IV functional class (FC) CHF increased from 6.1 % to 8.2 % whereas III-IV FC CHF increased from 1.8 % to 3.1 %. The main causes for the development of CHF remained arterial hypertension and ischemic heart disease; the role of myocardial infarction and diabetes mellitus as causes for CHF was noted. For the analyzed period, the number of treatment components and the coverage of basic therapy for patients with CHF increased, which probably accounts for a slower increase in the disease prevalence by 2007-2017. The prognosis of patients was unfavorable: in I-II FC CHF, the median survival was 8.4 (95 % CI: 7.8-9.1) years and in III-IV FC CHF, the median survival was 3.8 (95 % CI: 3.4-4.2) years.

Experience of introducing a new form of organization of medical care for patients with heart failure in the Russian Federation.

Aim    To present clinical characteristics of patients after hospitalization for acute decompensated heart failure (ADHF) and to analyze hemodynamic indexes and compliance with the treatment at two years depending on the conditions of outpatient follow-up.Material and methods    The study included 942 patients with chronic heart failure (CHF) older than 18 years who had been hospitalized for ADHF. Based on patients' decisions, two groups were isolated: patients who continued the outpatient follow-up at the Center of CHF (CCHF) (group 1, n=510) and patients who continued the follow-up in outpatient multidisciplinary clinics (OMC) at their place of residence (group 2, n=432). The clinical portrait of patients was evaluated after ADHF, and hemodynamic parameters were evaluated on discharge from the hospital. Also, the patient compliance with the treatment was analyzed during two years of follow-up. Statistical analysis was performed with Statistica 7.0 for Windows.Results    The leading causes for CHF included arterial hypertension, ischemic heart disease, atrial fibrillation, and type 2 diabetes mellitus. With the mean duration of hospitalization of 11 inpatient days, 88.1 % and 88.4 % of patients of groups 1 and 2 were discharged with complaints of shortness of breath; 62 % and 70.4 % complained of palpitations; and 73.6 % and 71.8 % complained of general weakness. On discharge from the hospital, the following obvious signs of congestion remained: peripheral edema in 54.3 % and 57.9 %; pulmonary rales in 28.8 % and 32.4 %; orthopnea in 21.4 % and 26.2 %; and cough in 16,5 % and 15.5 % of patients of groups 1 and 2, respectively. For the time of hospitalization, CHF patients did not achieve their targets of systolic BP (SBP), diastolic BP (DBP) and heart rate (HR). Patients of group 1 achieved the recommended values of SBP, DBP and HR already at one year of the follow-up at CCHF. Patients of group 2 had no significant changes in hemodynamic indexes. At one and two years of the follow-up, group 2 showed a considerable impairment of the compliance with the basis therapy for CHF compared to group 1.Conclusions    During the short period of hospitalization (11 inpatient days), the patients retained pronounced symptoms of HF and clinical signs of congestion and did not achieve their hemodynamic targets. The patients who were followed up for a long time at CCHF were more compliant with the basis therapy, which resulted in improvement of hemodynamic indexes, compared to the patients who were managed in OMS at the place of residence.

[Patients after acute decompensation of Heart Failure: adherence to self-monitoring and treatment depending on the mode of outpatient monitoring].

Aim      To evaluate compliance with self-monitoring and drug and non-drug treatment of patients after ADHF during the management at a specialized center for CHF treatment (CCHF) or in real-life clinical practice.Material and methods  The study included 942 CHF patients after ADHF. In two years, the entire sample of patients was retrospectively divided into 4 groups based on their compliance with the management at the CCHF: group 1, 313 patients who were managed at the CCHF continuously for two years; group 2, 383 patients who choose the management at district outpatient clinics after discharge from a hospital; group 3, 197 patients who visited the CCHF for one year but then stopped the management; and group 4, 49 patients who initially preferred the management at district clinics but then switched to constant management at the CCHF. Compliance with recommendations was analyzed by data of outpatient clinical records or by data of structured telephone calls for patients who did not visit the CCHF or did not follow the visit schedule. Statistics was performed with a Statistica 7.0 for Windows software package.Results Patients of groups 2 (72.4 %) and 3 (88.3 %) performed self-monitoring less frequently whereas patients of groups 1 (94.6 %) and 4 (87.8 %) performed self-monitoring more frequently (р1 / 3=0.01, р1 / 2<0.001, р1 / 4=0.07, р2 / 4=0.02, р2 / 3<0.001, р4 / 3=0.9). Patients of group 2 (58.1 %) performed self-monitoring of heart rate less frequently than patients of groups 1, 3, and 4 (90.7 %, 81.7 %, and 87.8 %; р1 / 3=0.003, р1 / 2<0.001, р1 / 4=0.5, р2 / 4<0.001, р2 / 3<0.001, and р4 / 3=0.3). Patients of group 2 performed body weight self-monitoring less frequently than patients of groups 1, 3, and 4 (78.6 %, 67.9 %, and 72.9 %; р1 / 3=0.008, р1 / 2<0.001, р1 / 4=0.4, р2 / 4=0.002, р2 / 3<0.001, and р4 / 3=0.5). Compliance with the diet and restriction of salt consumption was 32.3 % and 37.5 % in groups 1 and 4, and 24.9 % and 19.9 % in groups 2 and 3 (р1 / 3=0.002, р1 / 2=0.03, р1 / 4=0.5, р2 / 4=0.02, р2 / 3=0.2, and р4 / 3=0.009). Compliance with recommendations on physical rehabilitation was 44.7% in group 1, which was better than in groups 2, 3, and 4 (8.2 %, 21.6 %, and 9.1 %; р1 / 2<0.001, р1 / 3=0.0003, р1 / 4=0.002, р2 / 4=0.9, р2 / 3=0.0006, and р4 / 3=0.2). At the end of the second year of follow-up, the actual proportion of patients taking ACE inhibitors/angiotensin receptor antagonists was low in groups 2, 3, and 4 (43.2 %, 45 %, and 66.7 %) and satisfactory in group 1 (92.4 %; р1 / 2<0.001, р1 / 3<0.001, р1 / 4<0.001, р2 / 3=0.6, р2 / 4=0.05, and р3 / 4=0.05). Proportion of patients taking beta-blockers was greater in group 1 (97.2 %) than in groups 2, 3. and 4 (73.2 %, 71.1 %, and 90.5 %; р1 / 2<0.001, р1 / 3<0.001, р1 / 4=00.08, р2 / 3=0.6, р2 / 4=0.1, and р3 / 4=0.06). Patients of group 1 (96.2 %) showed good compliance with the mineralocorticoid receptor antagonist treatment compared to groups 2, 3, and 4 (58.8 %, 55.4 %, and 81.2 %; р1 / 2<0.001, р1 / 3<0.001, р1 / 4<0.001, р2 / 3=0.5, р2 / 4=0.1, and р3 / 4=0.Conclusion      Only scheduled management by a cardiologist of the specialized CCHF provided sufficient compliance with self-monitoring and drug and non-drug treatment of CHF during the long-term follow-up.

[Analysis of mortality in patients with heart failure after de-compen-sation during long-term follow-up in specialized medical care and in real clinical practice].

Background Mortality from chronic heart failure (CHF) remains high and entails serious demographic losses worldwide. The most vulnerable group is patients after acute decompensated HF (ADHF) who have a high risk of unfavorable outcome.Aim To analyze risks of all-cause death (ACD), cardiovascular death (CVD), and death from recurrent ADHF in CHF patients during two years following ADHF in long-term follow-up with specialized medical care and in real-life clinical practice.Material and methods The study successively included 942 CHF patients after ADHF. 510 patients continued out-patient treatment in a specialized CHF treatment center (CHFTC) (group 1) and 432 patients refused of the management in the CHFTC and were managed in out-patient clinics at the place of patient's residence (group 2). Causes of death were determined based on inpatient hospital records, postmortem reports, or outpatient medical records. Cases of ACD, CVD, death from ADHF, and a composite index (CVD and death from ADHF) were analyzed. Statistical analysis was performed with the software package Statistica 7.0 for Windows, SPSS, and statistical package R.Results Patients of group 2 were older, more frequently had functional class (FC) III CHF and less frequently FC I CHF compared to group 1. Women and patients with preserved left ventricular ejection fraction (LV EF) prevailed in both groups. Results of the Cox proportional hazards model for ACD, CVD, death from ADHF, and the composite mortality index showed that belonging to group 2 was an independent predictor for increased risk of death (р<0.001). An increase in CCS score by 1 also increased the risk of death (р<0.001). Baseline CHF FC and LV EF did not influence the mortality in any model. Female gender and a higher value of 6-min walk test (6MW) independently decreased the risk of all outcomes except for CVD. An increase in systolic BP by 10 mm Hg reduced risk of all fatal outcomes. At two years of follow-up in groups 2 and 1, ACD was 29.9 % and 10.2 %, (OR, 3.7; 95 % CI: 2.6-5.3; p <0.001), CVD was 10.4 % and 1.9 % (OR, 5.9; 95 % CI: 2.8-12.4; p<0.001), death from ADHF was 18.1 % and 6.0 % (OR, 3.5; 95 % CI: 2.2-5.5; p<0.001), and the composite mortality index was 25.2 % and 7.7 % (OR, 4.1; 95 % CI: 2.7-6.1; р<0.001). Analysis of all outcomes by follow-up period (3 and 6 months and 1 and 2 years) showed that the difference between groups 2 and 1 in risks of any fatal outcome was maximal during the first 6 months.Conclusion The follow-up in the system of specialized medical care reduces risks of ACD, CVD, and death from ADHF. The first 6 months following discharge from the hospital was a vulnerability period for patients after ADHF. The CCS score impaired the prognosis whereas baseline LV EF and CHF FC did not influence the long-term prognosis after ADHF. Protective factors included female gender and higher values of 6MW and systolic BP.

[The risks of re-hospitalization of patients with heart failure with prolonged follow-up in a specialized center for the treatment of heart failure and in real clinical practice.]

Relevance The number of patients with functional class III-IV chronic heart failure (CHF) characterized by frequent rehospitalization for acute decompensated HF (ADHF) has increased. Rehospitalizations significantly increase the cost of patient management and the burden on health care system.Objective To determine the effect of long-term follow-up at a specialized center for treatment of HF (Center for Treatment of Chronic Heart Failure, CTCHF) on the risk of rehospitalization for patients after ADHF.Materials and Methods The study successively included 942 patients with CHF after ADHF. Group 1 consisted of 510 patients who continued the outpatient follows-up at the CTCHF, and group 2 included 432 patients who refused of the follow-up at the CTCHF and were managed at outpatient clinics at their place of residence. CHF patient compliance with recommendations and frequency of rehospitalization for ADHF were determined by outpatient medical records and structured telephone calls. A rehospitalization for ADHF was recorded if the patient stayed for more than one day in the hospital and required intravenous loop diuretics. The follow-up period was two years. Statistical analyses were performed using a Statistica 7.0 software for Windows, SPSS, and a R statistical package.Results Patients of group 2 were significantly older, more frequently had FC III CHF and less frequently had FC I CHF than patients of group 1. Both groups contained more women and HF patients with preserved ejection fraction. Using the method of binary multifactorial logit-regression a mathematical model was created, which showed that risk of rehospitalization during the entire follow-up period did not depend on age and sex but was significantly increased 2.4 times for patients with FC III-IV CHF and 3.4 times for patients of group 2. Multinomial multifactorial logit-regression showed that the risk of one, two, three or more rehospitalizations within two years was significantly higher in group 2 than in group 1 (2.9-4.5 times depending on the number of rehospitalizations) and for patients with FC III-IV CHF compared to patients with FC I-II CHF (2-3.2 times depending on the number of rehospitalizations). Proportion of readmitted patients during the first year of follow-up was significantly greater in group 2 than in group 1 (55.3 % vs. 39.8 % of patients [odd ratio (OR) =1.9; 95% confidence interval (CI), 1.4-2.4; р<0.001]; during the second year, the proportion was 67.4 % vs. 28.2 % (OR=5.3; 95 % CI, 3.9-7.1; р<0.001). Patients of group 1 were readmitted more frequently during the first year than during the second year (р<0,001) whereas patients of group 2 were readmitted more frequently during the second than the first year of follow-up (р<0.001). Total proportion of readmitted patients for two years of follow-up was significantly greater in group 2 (78.0 % vs. 50.6 %) (OR=3.5; 95 % CI, 2.6-4.6; р<0.001). Reasons for rehospitalizations were identified in 88.7 % and 45.9 % of the total number of readmitted patients in groups 1 and 2, respectively. The main cause for ADHF was non-compliance with recommendations in 47.4 % and 66.7 % of patients of groups 1 and 2, respectively (р<0.001).Conclusion Follow-up in the system of specialized health care significantly decreases the risk of rehospitalization during the first and second years of follow-up and during two years in total for both patients with FC I-II CHF and FC III-IV CHF. Despite education of patients, personal contacts with medical personnel, and telephone support, main reasons for rehospitalization were avoidable.

[Papillary fibroelastoma in the cardiologist's practice].

The article presents a clinical case of diagnosis and treatment of a rare disease, multiple papillary fibroelastoma associated with a relapse and a complication in the form of cardioembolic stroke. The authors stressed difficulties in diagnostics of this disease and a special role of the physician-patient interaction.

[What new will implementation of European Guidelines for managing arterial hypertension introduce into real-life clinical practice?]

AIM: To analyze the effect of introducing new treatment goals in hypertension stated in the 2018 European Society of Cardiology and European Society of Hypertension Guidelines on prevalence and treatment efficacy of arterial hypertension (AH) in a representative sample of patients in the European part of the Russian Federation. MATERIALS AND METHODS: A representative sample of population in the European part of Russia was evaluated in 1998, 2002, 2007, and 2017. The structure of patients with AH was compared in these samples according to the 2013 and 2018 European Guidelines. RESULTS: Introduction of new guidelines for the treatment of AH in 2018 resulted in increasing the prevalence of hypertension from 35.5% to 36.9% in 1998, from 39.1% to 39.9% in 2002, from 451.0% to 41.3% in 2007, and from 43.3% to 43.6% in 2017. Proportion of effectively managed patients decreased from 4.7% to 3.5% in 1998, from 7.5% to 6.2% in 2002, from 17.0 to 14.7% in 2007, and from 30.8% to 26.4%. Proportion of patients who required initiation of antihypertensive therapy increased from 59.6% to 61.1% in 1998, from 47.9% to 49.1% in 2002, from 27.9% to 28.2% in 2007, and from 17.5% to 18.2% in 2017. CONCLUSION: The new requirements to diagnostic and treatment of AH provided by the 2018 European Society of Cardiology Guidelines insignificantly influenced prevalence and treatment efficacy of AH. At the same time, the new guidelines appeared rather difficult for application due to different values of blood pressure used for diagnostics and treatment goals.

Effect of exfoliating agent on rheological behavior of ß-chitin fibrils in aqueous suspensions and on mechanical properties of poly(acrylic acid)/ß-chitin composites.

Chitin whiskers are promising reinforcing filler for composites due to their mechanical properties, renewable nature and low cost. A new method for preparation of ß-chitin fibrils from squid pens in ascorbic acid aqueous solutions (AscA) was developed. Stirring of the solution with 2 g/l AscA for 2 h disperses the swollen chitin to individualized fibrils with an aspect ratio > 250. The optimal conditions of ß-chitin exfoliation in acrylic acid (AcrA) aqueous solution were found (0.75-2 g/l, 3-4 h). TEMPO-oxidized ß-chitin fibrils were chosen as a reference sample for comparison of different methods. 0.1% chitin suspensions exfoliated in AscA and AcrA solutions show similar gel-like behavior with a storage modulus (G') of 98 ±â€¯23 and 34 ±â€¯12 Pa, respectively, whereas G' of 0.1% dispersion of the TEMPO-oxidized ß-chitin fibrils was 0.015 ±â€¯0.005 Pa only. Composites based on poly(acrylic acid) comprising 1-3 wt% of ß-chitin fibrils were fabricated by polymerization filling. Mechanical properties of the composites were investigated in dry state in the temperature range of 25-250 °C and at controlled relative humidity in the range from 53.6% to 100%. It was revealed that the maximum reinforcing effect is achieved at high temperature (>120 °C) and high relative humidity (≥75.3%RH).

[Stability of chronic heart failure from the position of a doctor and a patient: in search of contact points].

Actuality. The results of the EPOCH study showed that in 16 years in the Russian Federation the number of patients with chronic heart failure (CHF) of I-IV FC increased significantly. The main objectives of the treatment of CHF are the stabilization of the patient's condition and the reduction of the risks of cardiovascular mortality, decompensation and repeated hospitalizations for heart failure. But a single concept of "stable" CHF does not exist either in Russian or in foreign recommendations. OBJECTIVE: To assess how ofen the subjective assessment of a doctor regarding the stability of a patient with CHF coincides with the subjective opinion of the patient with CHF regarding the stability of his condition; and to identify those parametrs that have a leading influence on the assessment of the stability of the state from the point of view of the physician and the patient. MATERIALS AND METHODS: Data collection was carried out in the form of interviews among general practitioners and cardiologists in outpatient clinics (OC) of Nizhny Novgorod, which were randomly selected by the method of blind envelopes. In parallel, a survey was conducted of patients with CHF who applied for outpatient medical care about this syndrome to this OC, which the doctors were not informed about, because patient interviews were conducted after the end of outpatient admission in a separate room. Answers of doctors about a patient with CHF were compared with the answers of the corresponding patient; for this, a single code was assigned to both questionnaires. The study included 211 patients with CHF of any etiology older than 18 years. The study involved 25 doctors. The study was conducted from 11/01/17 to 11/30/17. RESULTS: Analysis of the data suggests that the doctor is more likely to consider the patient more stable in cases when the patient notes a decrease in the severity of shortness of breath, weakness and does not detect edema, while the fact of therapy with loop diuretics (LD) or an increase in them did not affect assessment of stability from the point of view of the doctor. From the point of view of the patient, the absence of the first three signs also testifies to the stability of the condition, however, unlike doctors, patients more often (p <0.001) considered themselves unstable in those cases when they needed LD therapy or an increase in LD dose. A logit regression analysis and ROC analysis based on selected signs and symptoms of CHF confirmed that a model that combines questions about persistent weakness and edema is best suited to predict the patient's subjective assessment of patient's stability from a doctor's point of view (61.8% of the results can be correctly predicted), and at the cutoff threshold of 0.5, it has the highest sensitivity of 64.9%. To predict the subjective assessment of stability in relation to the patient, the optimal model turned out to be the one that includes answers to the questions of "shortness of breath", "weakness" and "intake of loop diuretics", which allows to predict 66.7% of the results correctly at the cut­off threshold 0, 5 has a better balance of sensitivity and specificity (54.9 and 78.6, respectively). CONCLUSION: Reducing the severity of dyspnea, weakness and lack of edema of the lower extremities are important signs of the stability of the condition, both in the opinion of the doctor and in the opinion of the patient. Unlike the doctor, the patient is more likely to be classified as unstable in those cases when he is forced to receive therapy with loop diuretics at the outpatient stage or to increase their dose. The model for assessing the stability of a patient with CHF from the point of view of a physician more often allows one to confirm the patient's stable condition, while the model used by patients more often allows to identify patient instability and worsening of the course of CHF.

[EPOCHA-D-CHF: gender differences in the prognosis of patients with CHF af-ter acute decompensation (part 2*)].

AIM: To study effects of gender differences in clinical and epidemiological factors on long-term prognosis for patients with acute decompensated heart failure (ADHF). MATERIALS AND METHODS: A retrospective, observational analysis of a sample of patients (n=718) hospitalized with signs of ADHF with subsequent collecting information about the endpoint (all-cause death) at four years. RESULTS: Age was a predictor of unfavorable outcome for both men and women (RR, 1.04, 95% CI, 1.02-1.06, p<0.001 and RR, 1.04, 95% CI, 1.03-1.06, p<0.001). Presence of lower extremity edema increased the risk of fatal outcome for men (RR, 2.03, 95% CI, 1.21-3.39, р=0.007) whereas for women, presence of ascites (RR, 3.43, 95% CI, 2.09-5.64, р<0.001) or orthopneic position on admission (RR, 1.51, 95% CI, 1.03-2.23, p=0.04) resulted in the increased risk. For both sexes, the prediction improved with every 10% increase in systolic BP on admission (RR, 0.87, 95% CI, 0.78-0.97, p=0.01 for men and RR, 0.84, 95% CI, 0.76-0.91, p<0.001 for women). Presence of diabetes mellitus affected the prediction only for women (RR, 1.80, 95% CI, 1.34-2.42, p<0.001). A history of myocardial infarction (RR, 1.40, 95% CI, 1.01-1.95, p=0.04 and RR, 1.44, 95% CI, 1.04-1.98, р=0.03), presence of communityacquired pneumonia (RR, 1.90, 95% CI, 1.32-2.74, p<0.001 and RR, 2.38, 95% CI, 1.55-3.68, p<0.001) adversely affected the prediction for men and women, respectively. At the end of study (4 years), the endpoint (all-cause death) was observed in 65.5% of men and 48.1% of women, median survival was 720 и 1168 days, respectively. CONCLUSIONS: Te long-term prognosis was worse for men hospitalized for ADHF. Presence of congestion signs impaired the prediction for both men and women. Patients with higher systolic BP on admission were characterized with beter survival. A history of diabetes mellitus for women and myocardial infarction or community acquired pneumonia for both sexes worsened the long-term prediction.

[Prognosis of the life of patients with chronic heart failure and atrial fibrilla-tion, depending on the control of hemodynamic parameters and tolerance to physical exertion in the background of basic therapy].

Actuality. In the basic therapy of CHF, drugs that reduce the pulse is one of the leading places. Target values of heart rate with sinus rhythm are established. Tere is still no consensus as to which heart rate is ideal in patients with CHF on the background of the rhythm of atrial fbrillation (AF). Te study of the prognosis in patients with CHF and AF depending on the achieved heart rate is relevant. OBJECTIVE: To analyze the overall mortality and establish the stratifcation risks of death in patients with CHF and AF depending on the form of AF, functional class of CHF and the presence of tachycardia. MATERIAL AND METHODS: A prospective cohort study was conducted in a group of patients with CHF who were observed at the City Center for CHF treatment (n = 591) during the year. Of these, 47.4% of patients had CHF and AF (n = 280) and 52.6% of patients with CHF without AF (n = 311). RESULTS: In a year, a permanent AF registered among patients with CHF and AF in 55.4%, persistent - in 36.4%, and paroxysmal - in 8.2% of cases. In 12.2% of patients, the diagnosis of AF was frst diagnosed. According to functional class of CHF, LVEF, assessment of clinical assessment scale, the group with a permanent AF was signifcantly heavier than without AF. Te mortality of patients with tachycardia signifcantly increased as a function of the increase in CHF from I-II to III-IV class: from 3.6% to 14.9% in the group without AF (p=0.04), and in the group with paroxysmal and persistent AF from 6.7% to 25.9% (p = 0.043). Te presence of tachycardia increases the risk of death by 61%, and the transition to a heavier functional class is 4.9 times. With each increase in the clinical assessment scale exponent by 1 point, the mortality rate in the sample is increased by 16%. CONCLUSION: Heart rate is not an independent predictor of death, but in combination with functional class III-IV CHF tachycardia signifcantly worsens the prognosis.

EPOCHA-AH 1998­2017. Dynamics of prevalence, awareness of arterial hypertension, treatment coverage, and effective control of blood pressure in the European part of the Russian Federation.

AIM: To perform a repeated epidemiological study of a representative sample in the European part of the Russian Federation in 2017 and to compare the dynamics of arterial hypertension (AH) prevalence with the effectiveness of blood pressure (BP) control in the population compared to 1998, 2002, and 2007. MATERIALS AND METHODS: A representative sample of the European part of the Russian Federation was created in 2002 and re-examined in 2007 and 2017. In 1998, a pilot project was performed for examining a representative sample for the Nizhniy Novgorod region. RESULTS: During 19 years of follow-up, the AH prevalence increased from 35.5 to 43.3%. Te awareness and treatment coverage reached 76.9 and 79.3%, respectively, in 2017. Achievement of the target BP with a single measurement also increased among patients receiving antihypertensive medication from 14.3 to 34.9%. For the treatment of AH, medium-acting antihypertensive drugs are used, ofen at suboptimal doses. CONCLUSION: Epidemiological indices of awareness, treatment coverage, and number of effectively managed patients with AH have improved. However, the AH prevalence has increased by 7.8% for 19 years, which indicates inefciency of the primary prevention of this disease.

[Effectiveness of control over hemodynamic indexes and prognosis for patients with CHF and atrial fibrillation in real-life clinical practice].

BACKGROUND: Earlier studies have demonstrated a high prevalence of atrial fibrillation (AF) in patients with CHF. It was noticed that tachycardia and hypotension provoked high risks for cardiovascular mortality. The presence of arterial hypertension (AH) in CHF patients also impairs life prognosis. AIM: To determine prognosis for patients based on the control of hemodynamic indexes and titration of pulse-slowing therapy in real-life clinical practice. MATERIALS AND METHODS: This prospective study with a one-year followup period included 580 patients after decompensated CHF who were discharged from the Municipal Center for Treatment of CHF. 46.9% of patients had AF. Patients with AF were divided into groups with paroxysmal and persistent AF (combined) and permanent AF. RESULTS: Among patients with CHF and AF, 56.3%, 38.6%, and 5.1% had permanent, persistent, and paroxysmal AF, respectively. Patients with permanent AF had a higher CHF FC. The FC was evaluated using the 6­min walk test and Clinical Condition Scale at baseline and after the one-year follow-up. Incidence of hypotension and tachycardia was higher in the group with permanent AF. In patients without AF, baseline systolic blood pressure (SBP) (139.5±24.5 mm Hg) was higher than in patients with any AF type (132.1±24.2 mm Hg, p.

[Time-related changes in prevalence of chronic heart failure and diabetes mellitus in Nizhny Novgorod Region between 2000 and 2017].

AIM: To determine time-related changes in prevalence, morbidity, and all-cause mortality of patients with CHF depending on the presence of DM in a representative sample of Nizhny Novgorod Region. MATERIALS AND METHODS: In 1998, a representative sample of Nizhny Novgorod Region was created, which included 1922 respondents. From 2000 through 2017, this sample was evaluated three times. Patients with CHF and DM were studied. RESULTS: For 17 years, prevalence of NYHA FC IV CHF increased from 6.88 to 9.1 % (р=0.04). Prevalence of NYHA FC III-IV CHF increased considerably from 1.2 % to 4.8 % (р.

[The notion of CHF course stability: Is it acceptable for Russian practice?]

AIM: To evaluate preparedness of physicians in real clinical practice to strive for stabilizing the course of CHF by control of clinical and hemodynamic indexes both in prevention of admission for decompensated CHF and following discharge from the hospital. MATERIALS AND METHODS: The study included 750 CHF patients with any NYHA FC who were admitted in emergency for decompensated CHF. All patients with CHF were followed up for a year after discharge from the hospital. Medical records of inpatients (MRIP) and outpatients (MROP) were analyzed including determination of clinical symptoms and administered doses of medicines. Changes in clinical parameters during a year were recorded. RESULTS: CHF decompensation was evident as pulmonary edema in 1.6% of cases and acute left ventricular failure in 18.5% of cases. All the rest of decompensated CHF cases included ascites or hyposarca (21.1%), or increased edema syndrome with unstable hemodynamics (58.5%). In MROPs, weight control was presented for 1.2% of patients. The composite index of effectively achieved control of hemodynamics and body weight was only 0.2%. Treatment effectiveness decreases due to absence of drug titration and switching therapies, which considerably impairs prognosis for patients. CONCLUSION: Outpatient physicians lack alertness for development of CHF decompensation, and control of hemodynamics and body weight of patients remains ineffective. Physicians are not prepared to achieve recommended doses of medicines, which provokes high risk of fatal outcome and/or rehospitalization.

Predictors of community-acquired pneumonia in patients with acute decompensated heart failure: the results of the analysis of the hospital sample EPOHA-D-CHF.

AIM: Identify the most significant predictors of community-acquired pneumonia and their im-pact on the risk of this disease in patients with ADHF. MATERIALS AND METHODS: The analysis of the hospital sample of patients (n=852) with ADHF. In 16.5% of hospitalizations, community-acquired pneumonia was found. RESULTS: The presence of symmetrical rales in the lungs, hepatomegaly, left ventricular failure signs, dilated cardiomyopathy, hypotension are increasing the risk of pneumonia in 3.7 (p<0.001), 1.6 (p=0.02), 1.86 (p=0.005), 1.72 (p=0.002), 2.7 (p=0.003) times. CONCLUSION: Based on results of a single and multivariate regression analysis, the risk of pneumonia is statistically significant increase in patients with acute left ventricular failure, dilated cardiomyopathy, hypotension, with signs of stagnation in the small and large circulatory circles. Different combinations of these predictors were found in 80% of patients with ADHF, among which in 20% of cases there was a combination of 3-5 factors.