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...
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.
Цель. Изучить эффективность, безопасность и влияние на сосудистый возраст раздельных и фиксированных комбинаций амлодипина, блокатора ренин-ангиотензин-альдостероновой системы и розувастатина у пациентов высокого и очень высокого кардиоваскулярного риска с неконтролируемым течением артериальной гипертонии и сопутствующей дислипидемией. Материал и методы. В открытое сравнительное исследование (серия случаев) было включено 148 мужчин и женщин (средний возраст 60,63±8,16 лет). Пациенты случайно были разделены на 2 группы: группа 1 (n=76) получала фиксированную трехкомпонентную комбинацию амлодипин, лизиноприл, розувастатин; группа 2 (n=72) получала двухкомпонентную свободную гипотензивную комбинацию (амлодипин/лозартан) и розувастатин. Дозовые формы подбирались исходя из рекомендаций лечащего врача поликлиники и не регламентировались исследователями. Исследование включало в себя оценку артериального давления, липидного профиля (общего холестерина (ОХС), холестерина липопротеинов низкой плотности (ХС-ЛНП), холестерина липопротеинов высокой плотности, триглицеридов), стандартных биохимических показателей, сердечно-сосудистых рисков (ССР) по шкале ASCORE, приверженности к терапии, изменения индекса аугментации (ИА) на начальном этапе и спустя 6 мес. терапии (первый и второй визиты, соответственно). Результаты считались статистически достоверными при p<0,05. Результаты. Спустя 6 мес. терапии отмечены достоверные внутригрупповые различия в сравнении с исходными значениями, в т. ч. для группы 1 значимо снизились уровни ОХС (р=0,002), ХС-ЛНП (р=0,001), ССР по шкале ASCORЕ (р=0,01) и сосудистый возраст (р=0,01); для группы 2 -ОХС (р=0,03), ХС-ЛНП (р=0,005). В группе фиксированной трехкомпонентной терапии значения ИА (p=0,04), ОХС (р=0,012), ХС-ЛНП (р=0,024), ССР по шкале ASCORE (р=0,02) и сосудистого возраста (р=0,01) были значимо ниже, чем в группе свободной комбинации. Заключение. Фиксированная комбинация, включающая амлодипин, лизиноприл и розувастатин, является более эффективной и равно безопасной относительно свободной комбинации, содержащей амлодипин/лозартан и розувастатин, не только по влиянию на ХС-ЛНП и ИА, что обусловлено лучшей "вынужденной" приверженностью к статинотерапии, но и на показатели "сосудистого возраста", рассчитанного с использованием шкалы ASCORE, что может служить дополнительным фактором увеличения мотивации пациентов к приему прогноз-модифицирующей терапии. Ключевые слова: сосудистый возраст, артериальная гипертензия, дислипидемия, сердечно-сосудистый риск. Отношения и деятельность. Работа частично выполнена по Государственному заданию в рамках бюджетной темы № АААА-А17-117112850280-2. 1 ФГБОУ ВО Новосибирский государственный медицинский университет Минздрава России, Новосибирск; 2 Научно-исследовательский институт терапии и профилактической медицины -филиал ФГБНУ Федеральный исследовательский центр Институт цитологии и генетики Сибирского отделения Российской академии наук, Новосибирск, Россия.(p=0,001), ASCORE value (p=0,01), and vascular age (p=0,01) significantly decreased; in group 2 -TC (p=...
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.
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