The international AKTIV register presents a detailed description of out- and inpatients with COVID-19 in the Eurasian region. It was found that hospitalized patients had more comorbidities. In addition, these patients were older and there were more men than among outpatients. Among the traditional risk factors, obesity and hypertension had a significant negative effect on prognosis, which was more significant for patients 60 years of age and older. Among comorbidities, CVDs had the maximum negative effect on prognosis, and this effect was more significant for patients 60 years of age and older. Among other comorbidities, type 2 and 1 diabetes, chronic kidney disease, chronic obstructive pulmonary disease, cancer and anemia had a negative impact on the prognosis. This effect was also more significant (with the exception of type 1 diabetes) for patients 60 years and older. The death risk in patients with COVID-19 depended on the severity and type of multimorbidity. Clusters of diseases typical for deceased patients were identified and their impact on prognosis was determined. The most unfavorable was a cluster of 4 diseases, including hypertension, coronary artery disease, heart failure, and diabetes mellitus. The data obtained should be taken into account when planning measures for prevention (vaccination priority groups), treatment and rehabilitation of COVID-19 survivors.

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 organizer of the registers “Dynamics analysis of comorbidities in SARSCoV-2 survivors” (AKTIV) and “Analysis of hospitalizations of comorbid patients infected during the second wave of SARS-CoV-2 outbreak” (AKTIV 2) is the Eurasian Association of Therapists (EAT). Currently, there are no clinical registries in the Eurasian region designed to collect and analyze information on long-term outcomes of COVID-19 survivors with comorbid conditions. The aim of the register is to assess the impact of a novel coronavirus infection on long-term course of chronic non-communicable diseases 3, 6, 12 months after recovery, as well as to obtain information on the effect of comorbidity on the severity of COVID-19. Analysis of hospitalized patients of a possible second wave is planned for register “AKTIV 2”. To achieve this goal, the register will include men and women over 18 years of age diagnosed with COVID-19 who are treated in a hospital or in outpatient basis. The register includes 25 centers in 5 federal districts of the Russian Federation, centers in the Republic of Armenia, the Republic of Kazakhstan, the Republic of Kyrgyzstan, the Republic of Belarus, the Republic of Moldova, and the Republic of Uzbekistan. The estimated capacity of the register is 5400 patients.

Aim. To study the lipid profile in hospitalized patients with coronavirus disease 2019 (COVID-19) depending on the outcome of its acute phase according to the AKTIV international registry.Material and methods. The AKTIV registry included men and women over 18 years of age with a diagnosis of COVID-19, who were treated in a hospital. A total of 9364 patients were included in the registry, of which 623 patients were analyzed for levels of total cholesterol, low-density lipoprotein cholesterol (LDL-C) and triglycerides on days 1-2 of hospitalization. The level of high-density lipoprotein cholesterol (HDL-C) was calculated using the Friedewald equation.Results. We found that a decrease in LDL-C level was significantly associated with an unfavorable prognosis for hospitalized patients with COVID-19. This pattern persisted in both univariate and multivariate analyses. LDL-C levels in the final multivariate model had a significant relationship with the prognosis (an increase in the death risk by 1,7 times with a decrease per 1 mmol/l). In addition, we found that the survival of patients with an indicator level of <2,45 mmol/l is significantly worse than in patients with an LDL-C level ≥2,45 mmol/l. All patients with high LDL-C ((≥4,9 mmol/l) survived, while among patients with low LDL-C (<2,45 mmol/l. All patients with high LDL-C ((≥4,9 mmol/l) survived, while among patients with low LDL-C (<1,4 mmol/l), mortality was 13,04%, which was significantly higher than in patients with LDL-C ≥1,4 mmol/l (6,32%, p=0,047).Conclusion. A decrease in LDL-C in the acute period is significantly associated with an unfavorable prognosis for hospitalized patients with COVID-19. Determination of LDL-C can be included in the examination program for patients with COVID-19. However, the predictive value of this parameter requires further study in prospective clinical studies.

Asthma and chronic obstructive pulmonary disease remain major problems of medicine, and still there is need to improve the level and quality of diagnosis of these diseases. Primary care physicians (general practitioners, therapists) should be involved widely and actively in this process. To simplify the diagnosis, special questionnaires have been developed, they can be used in a real clinical practice. Only this approach will bring statistical data closer to the true prevalence of these diseases and improve quality of their treatment.

The medical and social significance of cardiovascular diseases remains high. One of the factors that determine cardiovascular risks is metabolic syndrome. As a result of excessive accumulation of lipid and carbohydrate metabolism products in metabolic syndrome, oxidative (oxidative) stress develops. The article considers both domestic and foreign scientific studies, which highlight various aspects of the influence of reactive oxygen and nitrogen species, as well as other free radicals on the formation of oxidative stress in pathological conditions that are part of the metabolic syndrome complex. This describes the mechanisms of the formation of chronic inflammation through excessive secretion of pro-inflammatory cytokines and adipokines, activation of the transcription factor NF-kB, as well as damage to the antioxidant system in obesity. Separately, a number of mechanisms of the stimulating effect of adipokines: leptin, adiponectin, chimerine, omentin 1, resistin, on the formation of oxidative stress have been noted. The ways of activating the polyol pathway, as well as diacyl-glycerol — protein kinase C — the signaling pathway of oxidative stress, the formation of mitochondrial dysfunction is described. As a result of which there is an excessive production of free radicals in insulin resistance, diabetes mellitus and macroand microvascular complications of diabetes. In addition, the influence of oxidative stress directly on the formation of cardiovascular diseases of atherosclerotic genesis, as well as arterial hypertension, has been shown.

Bronchial asthma is a heterogeneous disease that requires identification of its phenotype and a personalized approach to therapy. At the same time, despite a wide range of therapeutic options, many patients with asthma cannot achieve control over the disease.Methodology. The target audience of these clinical recommendations are general practitioners, therapists, pediatricians, allergologists-immunologists, pulmonologists, and functional diagnostics doctors. Each thesis-recommendation about diagnostic and therapeutic procedures has been scored according to the scales of classes of recommendations from 1 to 5 and A, B, C scale of the levels of evidence. The clinical recommendations also contain comments and explanations to the theses, algorithms for the diagnosis and treatment of bronchial asthma, and reference materials.Conclusion. The presented clinical guidelines cover current information about the etiology and pathogenesis, classification, clinical manifestations, diagnosis, treatment, and prevention of bronchial asthma. These guidelines were approved by the Scientific and Practical Council of the Ministry of Health of the Russian Federation in 2021.

Introduction. During the pandemic COVID-19, patients suffering from arterial hypertension were noticed to have more severe course of the coronavirus infection. Due to this reason there has been an increased interest to arterial hypertension as a predictor of unfavorable course of the disease. Aim. To conduct a literature review on the impact of cardiovascular diseases (including arterial hypertension) on the course and outcome of the novel coronavirus infection COVID-19. Materials and methods. The PubMed and eLibrary database was searched for information over the past five years on selected inclusion criteria. Information requests included the following keywords: COVID-19, cardiovascular diseases, angiotensin converting enzyme inhibitors, angiotensin II receptor blocker, arterial hypertension, arterial stiffness. Results. A retrospective analysis of the database of patients hospitalized with confirmed coronavirus infection (5700 people) in a New York City hospital correlates with the results of the conducted registry in the Russian Federation (ACTIV SARS-CoV-2), which included 5808 people. These studies confirm a more severe course of coronavirus infection in patients with an aggravated comorbid background (cardiovascular diseases, diabetes mellitus, obesity), and therefore, the level of need for intensive care in this category of patients increases. The article examines the mechanisms of the pathogenesis of COVID-19 associated with the angiotensin converting enzyme type II. We present the study results on the use of angiotensin converting enzyme inhibitors and angiotensin II receptor blocker in patients with cardiovascular diseases and COVID-19. The latest literature data showing the correlation of cardiac biomarkers with the severity of coronavirus infection and the presence of concomitant hypertension were analyzed. The results of studies of arterial stiffness in patients with COVID-19 with and without arterial hypertension are presented. Conclusion. The retrospective analysis of multicenter studies, conducted in various countries of the world, allows us to identify risk factors for the severity of COVID-19 with the development of complications and an increase in mortality. Timely assessment of predictors in patients with confirmed coronavirus infection will reduce the mortality rate.