Vaccination against Streptococcus pneumoniae is among the most effective measures for preventing pneumonia and reducing the rate of chronic obstructive pulmonary disease (COPD) exacerbations. The objective of this work was to evaluate the long-term effectiveness of PCV13 and PPV23 for preventing pneumonia and COPD exacerbations. The open-label, prospective, observational cohort study involved 302 male patients aged ≥ 45 years: PCV13 group (n = 123); PPV23 group (n = 32); and vaccine-naïve group (n = 147). The primary endpoint included the frequency of pneumonia episodes and COPD exacerbations per year over a 5-year follow-up period. The secondary endpoints included the dynamics of dyspnea severity (MMRC), the BODE index, FEV1, the CAT index, the SGRQ score, and the results of 6-min walk test. Vaccination with PCV13 and PPV23 significantly reduces the total rate of pneumonia during the first year after vaccination. Starting with the second year, clinical effectiveness in PPV23 group decreases compared with both PCV13 group and vaccine-naïve patients. Pneumonia by year 5 after vaccination was registered in 47% of patients in the PPV23 group, versus 3.3% of patients in the PCV13 group (p < 0.001); COPD exacerbations—in 81.3% versus 23.6%, respectively (p < 0.001). Vaccination with PCV13 significantly reduced and maintained the BODE index over the 5-year follow-up period. Although both vaccines have comparable clinical effects during the first year after vaccination, only PCV13 is characterized by persistent clinical effectiveness during the 5-year follow-up period. Patients older than 55 years who received PPV23 have significantly higher risks of having pneumonia episodes more frequently during the long-term follow-up.

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The main views of the issue of stress and hy�ertension are briefly reviewed. it is well �nown that stress is one of the major ris� factors for cardiovascular disease develo�ment. increase in blood �ressure is a ty�ical manifestation of the acute stress res�onse. This fact is the reason to hy�othesize that chronic stress causes the develo�ment of hy�ertensive disease. an association of hy�ertension with �sychological stress in humans was shown in several wor�s. in addition�� it was demonstrated that hy�ertension was accom�anied by an increase in sym�athetic tone. on the other hand�� there were many �o�ulation studies in which no association was found between different ty�es of chronic stress and arterial hy�er-tension. Thus�� the question is far from being resolved. Even in cases when one managed to obtain a significant hy�ertensive effect in ex�erimental studies with emotional stress�� it was difficult to ex�lain the mechanisms mediating the formation of stressinduced hy�ertension. To clarify the situation�� one of the authors of this review decided to begin the breeding of a rat strain with increased blood �ressure res�onse to emotional stress. This breeding gave rise to inbred rats with �ersistent stressinduced arterial hy�ertension. The short history of develo�ment of the genetic model of stressinduced arterial hy�ertension�� the iSiaH rat strain�� is given. a retros�ective review of the studies �erformed with iSiaH rats is �resented. The contribution of genoty�e changes in the neuroendocrine systems involved in stress and blood �ressure regulation to the develo�ment of stress-de�endent hy�ertension in the iSiaH rat strain is shown.Key words�� stress; arterial hy�ertension; iSiaH rat strain.В кратком о�зоре изложены взгляды на про�лему стресса и артериал��ной гипертонии. Известно�� �то стресс является одним из существенных факторов риска за�олеваний серде�но-сосудистой системы. �овышение артериал��ного давления -типи�ное проявление острой стрессовой реакции. В связи с этим существует гипотеза о том�� �то состояние хрони�еского стресса может �ыт�� при�иной развития гипертони�еской �олезни. Имеется нескол��ко ра�от�� в которых описано нали�ие ассоциации артериал��ной гипертонии с психологи�еским стрессом у л�дей. �оказано�� �то артериал��ной гипертонии сопутствует повышение тонуса симпати�еской нервной системы. Но�� с другой стороны�� ест�� много популяционных ра�от�� в которых не �ыло о�наружено ассоциаций между разными видами хрони�еского стресса и гипертонией. таким о�разом�� вопрос остается далеким от разрешения. Даже в тех слу�аях�� когда удавалос�� полу�ит�� заметный гипертензивный эффект в экспериментал��ных ра�отах с применением эмоционал��ного стресса�� возникали трудности с о�ъяснением механизмов формирования стресс-индуцированной гипертонии. Для прояснения ситуации одним из авторов данной стат��и �ыла на�ата селекция крыс на повышенну� реакци� артериал��ного давления при действии эмоционал��ного стресса�� в резул��тате �его �ыла полу�ена ин�редная линия крыс со стойкой стресс-индуцированной артериал�...

The article uses the analysis of clinical and pharmacoeconomic effectiveness of 13-valent conjugated pneumococcal vaccine in patients with combined course of chronic obstructive pulmonary disease (COPD), ischemic heart disease (IHD) and chronic heart failure (CHF). Materials and methods. 429 male patients with diagnoses of COPD, IHD, CHF were included in the study. The main endpoints of observation, for 5 years, for evaluation of effectiveness were dynamic assessment for class CHF, the number of exacerbations, hospitalizations, the number of pneumonias. The 13-valent conjugated pneumococcal vaccine (PCV13) Prevenar-13 was used for vaccine prophylaxis. Results and discussion. The increase in age with the combined course of COPD and cardiovascular pathology leads to a deterioration in the basic clinical and functional indicators. With the increase in the clinical symptoms of the defeat of the respiratory system. There is an increase in the functional class of heart failure. Inclusion of vaccine prophylaxis PCV13 in the management plan of patients with combined pathology. Reduce the degree of dyspnea and stabilize the main functional indicators. Conclusions. Vaccination of patients with COPD using PCV13 combined with CHF and IHD made it possible to manage the health system expenses by 74-84%.

BackgroundVaccination against Streptococcus pneumoniae is among the most effective measures for preventing pneumonia and reducing the rate of chronic obstructive pulmonary disease (COPD) exacerbations. The objective of this work was to evaluate the long-term effectiveness of PCV13 and PPV23 for preventing pneumonia and COPD exacerbations.MethodsThe open-label, prospective, observational cohort study involved 302 male patients aged ≥45 years: PCV13 group (n=123); PPV23 group (n=32); and vaccine-naïve group (n=147). The primary endpoint included the frequency of pneumonia episodes and COPD exacerbations per year over a 5-year follow-up period. The secondary endpoints included the dynamics of dyspnea severity (MMRC), the BODE index, FEV1, the CAT index, the SGRQ score, and the results of 6-min walk test.ResultsVaccination with PCV13 and PPV23 significantly reduces the total rate of pneumonia during the first year after vaccination. Starting with the second year, clinical effectiveness in PPV23 group decreases compared with both PCV13 group and vaccine-naïve patients. Pneumonia by year 5 after vaccination were registered in versus 47% of patients in the PPV23 group 3.3% of patients in the PCV13 group (p<0.001); COPD exacerbations – in 81.3% versus 23.6%, respectively (p<0.001). Vaccination with PCV13 significantly reduced and maintained the BODE index over the 5-year follow-up period.ConclusionAlthough both vaccines have comparable clinical effects during the first year after vaccination, only PCV13 is characterized by persistent clinical effectiveness during the 5-year follow-up period. Patients older than 55 years on PPV23 have significantly higher risks of having pneumonia episodes more frequently during the long-term follow-up.

Most subjects with the COVID-19 experience mild to moderate symptoms, but approximately 10% of cases suffer from severe course of disease. IL-6 inhibitors are actively used to neutralize and prevent the cytokine storm. Olokizumab is a humanized monoclonal antibody belonging to the G4/Kappa immunoglobulin isotype that selectively binds to human IL-6 and effectively neutralizes it. Aim.To evaluate the efficacy and safety of Artlegia (olokizumab) for the treatment of subjects with a disease caused by the SARS-COV-2 virus in a real-world clinical setting. Materials and methods.The analysis included data of 610 subjects aged 55.0812.68 years who received olokizumab at a single dose of 160 mg/mL 0.4 mL subcutaneously as a preemptive anti-inflammatory therapy. The comparison group included 511 subjects aged 55.2311.23 years who received standard therapy without IL-6 inhibitors. Control Endpoints: 1. Positive clinical changes on Day 7. 2. Changes in the CRP levels on Days 1, 2, and 7. 3. Duration of oxygen therapy. 4. Number of days in hospital. 5. Number of adverse events. 6. Disease outcome. Results.If a cytokine storm occurs, immune regulatory events will trigger the development of either a protective immune response or an exacerbated inflammatory response. The use of preemptive anti-inflammatory therapy has both a short-term and, most importantly, a long-term effect on the T and B parts of the immune process. These aspects definitely require further research and observation. Conclusion.The use of olokizumab to treat the new COVID-19 coronavirus disease has demonstrated a positive effect on clinical and laboratory parameters. Primarily, it affects the severity of clinical parameters by improving the general condition already on the first day of observation, and decreasing body temperature to normal values. The changes in the C-reactive protein levels show a significant effect of the IL-6 inhibitor on the systemic inflammatory response.

Aim. The analysis of the dynamics of compliance in patients with chronic obstructive pulmonary disease (COPD) on a background of vaccination. Material and Methods. A total of 394 male patients are covered by this study. The main endpoints of observation are as follows: 1. To evaluate the effectiveness It’s important the dynamics of scores for mMRC, FEV1, the number of exacerbations, hospitalizations, the number of pneumonia cases. 2. To assess compliance it’s necessary to conduct a test for adherence to the Moriska-Green questionnaire. For vaccine prophylaxis, 13-valent conjugated pneumococcal vaccine Prevenar-13 and a 23-valent polysaccharide vaccine Pnevmo23 were used. The dynamics of changes in the parameters studied was evaluated within 4 years of the therapy initiation. Results. The inclusion of vaccine prophylaxis of PCV13 in the patient management plan allows to reduce a degree of dyspnea and stabilize the main functional parameters of the respiratory system not only in the short term, but also for at least next 4 years. PCV13 vaccination of can be considered as a basic therapy along with bronchodilator therapy. The use of vaccine prophylaxis PCV13 significantly increases the compliance and adherence of patients to a therapy. Conclusions. The use of vaccine prophylaxis PKV13 significantly increases patients ' compliance and adherence to the therapy.

SummaryThe aim of this study was assessment of vaccination effects on quality of life and main prognostic scores in COPD patients. Methods. The study involved 362 male patients with COPD. Vaccination was done using 13 valent conjugate pneumococcal vaccine Prevenar 13 (PCV13) and polyva lent pneumococcal vaccine Pneumo 23 (PPV23). Quality of life was assessed using the Russian version of SRGQ and CAT questionnaire. Prognostic BODE, DOSE and ADO scores were calculated. Results. Vaccination with PCV13 and PPV23 was associated with improvement in quality of life in 1 year after vaccination, though this effect of PPV23 decreased to the 3 rd year. Quality of life questionnaires help to assess the therapeutic strategy chosen both in early and delayed follow up. BODE, DOSE, and ADO scores have demonstrated a reliable and statistically significant decrease in 1 year after vaccination; for PCV13, this effect maintained in 3 years after vaccination. Conclusion. Vaccination with PCV13 could reduce total 3 year healthcare expenses to 11,357 RUB (78%), partly due to long term maintenance of the effect of vaccination. This is an important advantage of PCV13 over PPV23 both from economic and clinical points of view.