Microbiota and Cardiovascular Diseases: Mechanisms of Influence and Correction Possibilities

The term "microbiota"  refers to the microbial  community  occupying a specific  habitat  with  defined  physical  and  chemical  properties  and  forming specific  ecological  niches.  The adult  intestinal  microbiota  is diverse.  It mainly  consists  of bacteria  of Bacteroidetes  and  Firmicutes  types.  The link between the gut microbiota  and cardiovascular disease (CVD) is being actively discussed.  Rapid progress  in this field is explained  by the development of new generation  sequencing methods and the use of sterile gut mice in experiments.  More and more data are being published about the influence of microbiota  on the development  and course of hypertension, coronary  heart disease (IHD), myocardial  hypertrophy, chronic heart failure (CHF) and atrial fibrillation (AF). Diet therapy,  antibacterial drugs,  pro- and prebiotics are successfully  used as tools to correct the structure of the gut microbiota of the macroorganism. Correction  of gut microbiota  in an experiment  on rats with coronary  occlusion  demonstrates  a significant  reduction in necrotic area. A study  involving  patients  suffering  from  CHF  reveals a significant  reduction  in the level of uric acid,  highly  sensitive C-reactive protein,  and creatinine. In addition to structural and laboratory changes  in patients with CVD when modifying the microbiota  of the gut, also revealed the effect on the course of arterial hypertension. Correction  of gut microbiota  has a beneficial  effect on the course of AF. We assume  that further active study of issues of influence and interaction of gut microbiota  and macroorganism may in the foreseeable future make significant  adjustments  in approaches to treatment of such patients.

MARKIZ study: screening for post-COVID-19 syndrome using a questionnaire to identify symptoms and risk factors for noncommunicable diseases

Aim. To provide data on the diagnostic and prognostic value of questionnaire survey for post-COVID-19 syndrome during screening and regular medical check-ups of employees, as well as preventive medical examinations.

Material and methods. This single-center cross-sectional comparative study involved 1120 people (92,1% of the general population — all employees of the organization), including 195 men (67,3% of the general population) and 925 women (79,5% of the general population). All participants filled out the post-COVID-19 syndrome (PS) detection questionnaire, the Hospital Anxiety and Depression Scale and the QAA-25p Adherence Assessment Questionnaire. Potential adherence to treatment was calculated using the SCOPA software. Statistical processing was performed using tools adapted for medical and biomedical research (Python language; Sklearn, NumPy, Pandas libraries) and Statistica 6.13 (StatSoft Inc., USA).

Results. As a result, 47% of respondents noted at least one symptom that reduces the quality of life and/or performance efficacy. In all subsamples, women reported symptoms more frequently than men. The most informative indicators associated with post-COVID-19 syndrome are age (Mann-Whitney U test, p=0,042), number of PS symptoms (Mann-Whitney U test, p=0,001), severity of PS symptom (Mann-Whitney U test, p= 0,004) and adherence to health care (Kruskal-Wallis H test, p=0,021). An increased level of anxiety is associated with all the analyzed symptoms, depression level with 6 symptoms, age with 5 symptoms, insufficient compliance with 3 symptoms.

Conclusion. PS questionnaire should be included in a comprehensive survey program of persons undergoing medical examinations. It is necessary to develop algorithms for the treatment and diagnosis of patients that take into account the number and severity of individual symptoms separately for men and women with consideration to their COVID-19 epidemiological status, as well as age and markers of anxiety, depression, and adherence to treatment.

Questionnaire for quantitative assessment of treatment adherence: modification for adolescents aged 15–17 years, validation, and reliability assessment

In Russia, the QAA-25 questionnaire is used to quantify the adherence to treatment of adult patients. The accumulated experience of its use made it possible to identify several cohorts of respondents, including adolescents, whose characteristics required special adaptation of the formulations of a number of questions.

Purpose. The study aimed at modifying the questionnaire for quantitative assessment of treatment adherence QAA-25 for adolescents aged 15–17 years and evaluate it according to the criteria of validity and the measure of consent.

Material and methods. In a descriptive one-stage study with the participation of 108 high school students at secondary schools in Omsk, the level of adherence to treatment was determined according to the QAA-25 scale, using traditional and alternative formulations of individual questions, with the formation of a modified scale and an assessment of its constructive and factor validity and a measure of consent.

Results. Applying various options for testing alternative questions, the possibility and expediency of using them to assess the adherence to treatment of adolescents, including separately evaluated subsamples of male and female individuals, was shown. 94% of respondents rated alternative questions as “more acceptable,» 5% of respondents «did not notice significant differences,» and 1% of respondents rated them as «less acceptable.» The QAA-25 scale modified for adolescents demonstrated good structural and internal validity (α = 0.818, αst = 0.857), with high reliability (consistent exclusion of scale items preserves the validity of the questionnaire in the range of 0.793–0.858) and almost perfect agreement (κ = 1.000).

Conclusion. The modified QAA-25 questionnaire is recommended to be used to assess the adherence to treatment and potential adherence to treatment of adolescents who have reached the age of 15 but have not reached the age of 18, both for research purposes and when making decisions related to the provision of medical care and the organization of preventive measures. 

The Scale of Quantitative Assessment Adherence to Treatment «QAA-25»: Updating of Formulations, Constructive and Factor Validity and a Measure of Consent

Aim: To update the definitions of selected questions of the "QAA-25" (quantitative adherence assessment) scale and evaluate it according to the criteria of validity and measure of agreement.

Materials and Methods. In a descriptive cross-sectional study including 200 patients with coronary heart disease, adherence was determined using traditional and alternative versions of selected questions of the QAA-25 scale, followed by assessment of construct validity, factor validity, and measure of agreement.

Results. Alternative question versions did not significantly affect test results, with 81% of respondents in the outpatient sample and 69% in the inpatient sample rating them as "more acceptable." The QAA-25 scale has good construct and internal validity (α – 0.818, αst – 0.832), with moderate agreement (κ – 0.562) and demonstrates high reliability of internal validity – when scale items are consistently excluded, α values remain in the 0.801-0.839 range.

Conclusion. The QAA-25 scale with modified question definitions should be used instead of the previous version of the scale. Good construct validity and factor validity, sufficient measure of agreement and specificity, high sensitivity and reliability of the QAA-25 scale allow to recommend it as a tool for assessing adherence to drug therapy, medical support, lifestyle modification and integral adherence to treatment in scientific and clinical practice.

Algorithms for adult outpatient care of coronavirus disease 2019 (COVID-19) and its Assumption

The paper presents algorithms for adult outpatient care of coronavirus disease 2019 (COVID-19) and its assumption.

Effective antihypertensive therapy: focus on adherence management

High medical adherence is a prerequisite for achieving goals in the treatment of hypertension (HTN). The majority of patients with HTN showed low adherence to treatment, which requires finding ways to solve this problem. This review describes the factors influencing adherence, ways of its assessment, and analyzes methods of increasing medical adherence in hypertensive patients. Noteworthy is the lack of publications describing the effectiveness of methods for increasing long-term (>2 years) adherence in hypertensive patients. The review also describes a not fully clear individualized approach, which consists in choosing a therapy regimen based on levels of medical adherence, medical follow-up and lifestyle modification.