Aim. To study the clinical course specifics of coronavirus disease 2019 (COVID-19) and comorbid conditions in COVID-19 survivors 3, 6, 12 months after recovery in the Eurasian region according to the AKTIV register. Material and methods.The AKTIV register was created at the initiative of the Eurasian Association of Therapists. The AKTIV register is divided into 2 parts: AKTIV 1 and AKTIV 2. The AKTIV 1 register currently includes 6300 patients, while in AKTIV 2 — 2770. Patients diagnosed with COVID-19 receiving in- and outpatient treatment have been anonymously included on the registry. The following 7 countries participated in the register: Russian Federation, Republic of Armenia, Republic of Belarus, Republic of Kazakhstan, Kyrgyz Republic, Republic of Moldova, Republic of Uzbekistan. This closed multicenter register with two nonoverlapping branches (in- and outpatient branch) provides 6 visits: 3 in-person visits during the acute period and 3 telephone calls after 3, 6, 12 months. Subject recruitment lasted from June 29, 2020 to October 29, 2020. Register will end on October 29, 2022. A total of 9 fragmentary analyzes of the registry data are planned. This fragment of the study presents the results of the post-hospitalization period in COVID-19 survivors after 3 and 6 months. Results. According to the AKTIV register, patients after COVID-19 are characterized by long-term persistent symptoms and frequent seeking for unscheduled medical care, including rehospitalizations. The most common causes of unplanned medical care are uncontrolled hypertension (HTN) and chronic coronary artery disease (CAD) and/or decompensated type 2 diabetes (T2D). During 3- and 6-month follow-up after hospitalization, 5,6% and 6,4% of patients were diagnosed with other diseases, which were more often presented by HTN, T2D, and CAD. The mortality rate of patients in the post-hospitalization period was 1,9% in the first 3 months and 0,2% for 4-6 months. The highest mortality rate was observed in the first 3 months in the group of patients with class II-IV heart failure, as well as in patients with cardiovascular diseases and cancer. In the pattern of death causes in the post-hospitalization period, following cardiovascular causes prevailed (31,8%): acute coronary syndrome, stroke, acute heart failure. Conclusion. According to the AKTIV register, the health status of patients after COVID-19 in a serious challenge for healthcare system, which requires planning adequate health system capacity to provide care to patients with COVID-19 in both acute and post-hospitalization period.
The current state of the Russian and foreign regulatory framework for off-label prescription of medicines is presented in the article. The existing problems of this specific drug therapy and possible solutions are described. Unfortunately, there are some gaps in the Russian legislation regarding the off-label medication use. Based on the clinical reality, in some cases, the “off-label” drugs prescription can be justified by the clinical condition of the patient, the lack of alternative approved drugs, and the availability of published scientific data that create the prerequisites for the effectiveness of this approach. When off-label drug prescribing as a forced measure, the doctor must provide a rationale for this prescription in the medical documentation, the conclusion of the consultation (with the participation of relevant specialists and the clinical pharmacologist) or the medical commission (with the participation of the administration representative), and the written informed consent of the patient or his legal representative. This information should be actively communicated to doctors in order to increase their legal literacy and prevent possible negative and legal consequences.
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.
Ассоциации потребления полифенольных соединений и риска артериальной гипертензии в популяцииДенисова Д. В., Березовикова И. П., Батлук Т. И., Щербакова Л. В., Воевода М. И.Цель. Выявление ассоциаций потребления полифенольных соединений в целом, а также их отдельных классов, с риском развития артериальной гипертензии (АГ) в популяции жителей г. Новосибирска возрастной группы 45-69 лет. Материал и методы. В 2003-2005гг проведено эпидемиологическое обследование населения 45-69 лет Новосибирска (международный проект HAPIEE "Детерминанты сердечно-сосудистых заболеваний в Восточной Европе: многоцентровое когортное исследование". Обследовано 9360 человек (4266 мужчин и 5094 женщины). Средний возраст обследованных 57,6 года. Оценку питания проводили с использованием полуколичественного частотного вопросника Food Frequency Questionnaire (FFQ). Для оценки содержания полифенольных соединений и их подклассов использована Европейская база Phenol-Explorer 3.6. В структуре каждой группы продукта были учтены привычки питания сибирской популяции, типично употребляемые продукты. АГ диагностировали при уровнях систолического артериального давления (САД) ≥140 мм рт.ст. и/или диастолического артериального давления (ДАД) ≥90 мм рт.ст., а также у лиц, имеющих нормальные значения артериального давления на фоне приема гипотензивных препаратов в течение последних двух недель до настоящего обследования. Результаты. Риск развития АГ в квартиле с самым высоким суммарным потреблением полифенольных соединений у мужчин на 33% меньше, чем в квартиле с самым низким потреблением, отношение шансов (ОШ) 0,67 (доверительный интервал (ДИ) 0,56-0,79), P=0,004, а у женщин, соответственно, на 37% меньше ОШ 0,63 (ДИ 0,54-0,74), P<0,001. Для отдельных классов полифенольных соединений: самый высокий уровень потребления флавоноидов предполагает снижение риска развития АГ у мужчин на 33% ОШ 0,67 (ДИ 0,57-0,80), P<0,001 и у женщин на 39% (ОШ 0,61, ДИ 0,57-0,71), P=0,002. Как для мужчин, так и для женщин вероятность развития АГ в квартиле потребления фенольных кислот ниже на 21% (ОШ 0,79, ДИ 0,66-0,94, P=0,002) и 16% (ОШ 0,84, ДИ 0,72-0,99, P<0,001), соответственно. У мужчин также значимо потребление подкласса других полифенолов (риск при максимальном употреблении снижается на 18%, ОШ 0,84 (ДИ 0,69-0,98), P=0,018). Заключение. В популяции г. Новосибирска (возрастная группа 45-69 лет) высокие уровни потребления полифенолов в целом, а также таких подклассов, как флавоноиды и фенольные кислоты, ассоциируются со снижением риска развития АГ. Российский кардиологический журнал. 2019;24(6):115-120 http://dx.Ключевые слова: артериальная гипертензия, полифенольные соединения, популяция. Конфликт интересов: не заявлен. Финансирование. Работа выполнена при частичной финансовой поддержке гранта Российского фонда фундаментальных исследований № 19-013-00800. Associations of polyphenolic compounds consumption and the risk of arterial hypertension in the populationDenisova D. V., Berezovikova I. P., Batluk T. I., Shcherbakova L. V., Voyevoda M. I. Российский кардиологический ж...
BACKGROUND: Numerous studies indicate a high incidence of various disorders of carbohydrate metabolism against the new coronavirus infection. These disorders aggravate the course of infection and increase mortality. Thereby, analysis of risk factors for unfavorable outcomes and assessment of the long-term consequences of COVID-19 in patients with impaired carbohydrate metabolism is of great importance.AIM: To investigate the association between carbohydrate metabolism disorders in COVID-19 patients and mortality, course of infection, long-term consequences, as well as to identify risk factors for an unfavorable disease course.MATERIALS AND METHODS: A retrospective analysis of data from the combined multicenter non-interventional real-world AKTIV and AKTIV 2 registries was performed. The sample included 9290 patients who had COVID-19 with varying severity from June 29, 2020, to November 29, 2020 (AKTIV) and from October 01, 2020, to March 30, 2021 (AKTIV 2). The patients were divided into 3 groups: Group 1 — patients with intact carbohydrate metabolism, n=6606; Group 2 — patients with newly diagnosed hyperglycemia (NDH), n=1073; Group 3 — patients with a history of type 2 diabetes mellitus (DM2), n=1611. The groups were assessed for clinical and laboratory parameters, comorbidities, mortality, carbohydrate metabolic status, and well-being during the infection and at 12 months.RESULTS: The prevalence of carbohydrate metabolism disorders (CMD) was 28,9%, with DM2 patients accounting for 17,3% and patients with newly diagnosed hyperglycemia (NDH) for 11,6%. The mortality rate of patients with hyperglycemia of any origin was 10.6%, which was significantly higher compared to patients without hyperglycemia (3,9%). The probability of lethal outcome increased 2,48-fold in the group of patients with DM2 and 2,04-fold in the group of patients with NDH. At the same time, the probability of a lethal outcome decreased 2,94-fold in patients without CMD. At 12 months, patients with CMD showed a significantly higher frequency and longer persistence of complaints. This trend was more pronounced in patients with DM2 than in those with NDH. Only 1,7% of patients from the NDH group had type 2 diabetes and were receiving oral hypoglycemic medications one year after the infection. A prognostic model was developed to determine the risk of lethal outcome. The model included such known predictors as concomitant ischemic heart disease, history of myocardial infarction or stroke, blood glucose level, and age.CONCLUSION: Carbohydrate metabolism disorders aggravate the course of COVID-19 and increase mortality. One year after infection, patients with DM2 and NDH were more likely to have symptoms typical for post-COVID syndrome, and NDH resolved in most cases after the infection.
Background Consumption of polyphenolic compounds from various food sources is associated with a reduction in cardiovascular risk factors. The region of residence, the food habits of the population, and age have a significant impact on consumption. Methods Participants: the Siberian urban population (Novosibirsk, HAPIEE study, 9324 (4,249 men and 5,075 women) aged 45-69. Dietary data collected using a 141-item food frequency questionnaire. Data on the polyphenols were taken from the Phenol-Explorer database (3.6). Total polyphenols (TPH) were considered as a sum of all individual classes: flavonoids, phenolic acids, stilbenes, lignans and other polyphenols and their food sources. The consumption of polyphenolic compounds in the age groups of 45-49, 50-54, 55-59, 60-64 and more than 65 years was analyzed. To assess the relationship between CVD risk factors and the consumption of TPH, the odds ratio was calculated in quartiles of TPH consumption (OR). Results The consumption of TPH in men was 1273 (647) and 1203 (626) mg/day in women (P < 0,05). The main class for both men and women were flavonoids, as well as phenolic acids. For men, respectively, 68 and 21% of the total consumption of TPH, for women 70 and 20%. Chances of developing hypertension in quartiles of high and low consumption of TPH showed a risk reduction in whole population by 58%, in quartiles of high and low consumption of total flavonoids - by 56% and phenolic acids - by 21%. The main sources of TPH were tea, coffee, fruits, vegetables and rye bread. With increasing age, both men and women experience a decrease in TPH consumption by 9.5 and 11%, respectively, of flavonoids - by 10.6 and 15%. This is due to a decrease in fruit consumption with increasing age. Conclusions The consumption of polyphenol compounds in the Siberian urban population associated with reduction of hypertension and determined by age. The study was carried out in the framework of budget theme No. AAAA-A17-117112850280-2. Key messages Consumption of polyphenolic compounds in the Siberian population is associated with a reduced risk of hypertension. In recommendations for the prevention of hypertension in the older age group, it is necessary to consider the increase in the consumption of fruits and berries from local sources.
Aim. To investigate on post-COVID period in patients of the Eurasian region.Material and methods. A total of 9364 consecutively hospitalized patients were included in ACTIV registry. Enrollment of patients began on June 29, 2020, and was completed on March 30, 2021, corresponding to the first and second waves of the pandemic. Demographic, clinical, and laboratory data, computed tomography (CT) results, information about inhospital clinical course and complications of COVID-19 during hospitalization were extracted from electronic health records using a standardized data collection form. The design included follow-up telephone interviews with a standard questionnaire at 3, 6, and 12 months to examine the course of post-COVID period.Results. According to ACTIV register, 63% of patients after COVID-19 had new adverse symptoms or exacerbations of the existing symptoms lasting for up to 1 year. After hospital discharge, 79,8% of patients sought unscheduled medical attention in the first 3 months, 79,1% at 4-6 months, and 64,8% at 7-12 months. Readmission rate was 11,8% in the first 3 months, 10,9% at 4-6 months, and 10,1% at 7-12 months. The most common reasons for unscheduled treatment in the first 3 months were uncontrolled hypertension, decompensated type 2 diabetes, destabilization of coronary artery disease, gastrointestinal disease, AF episodes, exacerbation of asthma and chronic obstructive pulmonary disease, decompensated heart failure (HF). The 12-month mortality of COVID-19 survivors after the discharge was 3,08%. Multivariate analysis showed that independent risk factors for fatal outcome were age (direct correlation), the levels of hemoglobin (inverse correlation), oxygen saturation (inverse correlation), and aspartate aminotransferase (direct correlation), as well as class III-IV HF, prior stroke, cancer, inhospital acute kidney injury. Based on these identified risk factors, a nomogram was constructed to determine the 3-month mortality risk after discharge.Conclusion. Analysis of ACTIV register showed that end of the acute phase of COVID-19 does not imply a complete recovery.
Primary hyperaldosteronism is an existence of a functional autonomous source with increased aldosterone production (full or partial) in relation to the renin-angiotensin system. Increased production of aldosterone by the adrenal cortex is the most common form of a secondary hypertension despite the low attention of internists to the problem. The success of a treatment and a prognosis of these patients depend on correct choice of screening (aldosterone/renin ratio) and clarifying diagnostic methods. There are clear algorithms for conducting these tests in accordance with Russian and International recommendations in the respective groups of patients. The purpose of this case report is to demonstrate the long way to diagnosis of primary hyperaldosteronism in a young patient with refractory hypertension, right adrenal adenoma, and clinical (convulsions, weakness) and laboratory signs of hypokalemia. It should not only have made the diagnosis easy, but it could have also absolutely justified the surgical tactics. Unfortunately, the final verification of the disease by carrying out a saline test was accomplished 13 years after the debut of hypertension and 10 years after the primary visualization of the adrenal adenoma.
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