Analysis of influence of background therapy for comorbidities in the period before infection on the risk of the lethal COVID outcome. Data from the international ACTIV SARS-CoV-2 registry («Analysis of chronic non-infectious diseases dynamics after COVID-19 infection in adult patients SARS-CoV-2»)

Aim      To study the effect of regular drug therapy for cardiovascular and other diseases preceding the COVID-19 infection on severity and outcome of COVID-19 based on data of the ACTIVE (Analysis of dynamics of Comorbidities in paTIents who surVived SARS-CoV-2 infEction) registry.Material and methods  The ACTIVE registry was created at the initiative of the Eurasian Association of Therapists. The registry includes 5 808 male and female patients diagnosed with COVID-19 treated in a hospital or at home with a due protection of patients' privacy (data of nasal and throat smears; antibody titer; typical CT imaging features). The register territory included 7 countries: the Russian Federation, the Republic of Armenia, the Republic of Belarus, the Republic of Kazakhstan, the Kyrgyz Republic, the Republic of Moldova, and the Republic of Uzbekistan. The registry design: a closed, multicenter registry with two nonoverlapping arms (outpatient arm and in-patient arm). The registry scheduled 6 visits, 3 in-person visits during the acute period and 3 virtual visits (telephone calls) at 3, 6, and 12 mos. Patient enrollment started on June 29, 2020 and was completed on October 29, 2020. The registry completion is scheduled for October 29, 2022. The registry ID: ClinicalTrials.gov: NCT04492384. In this fragment of the study of registry data, the work group analyzed the effect of therapy for comorbidities at baseline on severity and outcomes of the novel coronavirus infection. The study population included only the patients who took their medicines on a regular basis while the comparison population consisted of noncompliant patients (irregular drug intake or not taking drugs at all despite indications for the treatment).Results The analysis of the ACTIVE registry database included 5808 patients. The vast majority of patients with COVID-19 had comorbidities with prevalence of cardiovascular diseases. Medicines used for the treatment of COVID-19 comorbidities influenced the course of the infectious disease in different ways. A lower risk of fatal outcome was associated with the statin treatment in patients with ischemic heart disease (IHD); with angiotensin-converting enzyme inhibitors (ACEI)/angiotensin receptor antagonists and with beta-blockers in patients with IHD, arterial hypertension, chronic heart failure (CHF), and atrial fibrillation; with oral anticoagulants (OAC), primarily direct OAC, clopidogrel/prasugrel/ticagrelor in patients with IHD; with oral antihyperglycemic therapy in patients with type 2 diabetes mellitus (DM); and with long-acting insulins in patients with type 1 DM. A higher risk of fatal outcome was associated with the spironolactone treatment in patients with CHF and with inhaled corticosteroids (iCS) in patients with chronic obstructive pulmonary disease (COPD).Conclusion      In the epoch of COVID-19 pandemic, a lower risk of severe course of the coronavirus infection was observed for patients with chronic noninfectious comorbidities highly compliant with the base treatment of the comorbidity.

Serotonin content in human blood platelets is not stable

A large variation of platelet serotonin content over short time intervals has been shown. This oscillation of platelet serotonin does not result from the accumulation of random technical variations, but can be considered as an objectively existing phenomenon which might be due to alternation of serotonin release and uptake processes in platelet-rich plasma. Sex and age do not influence the variation of platelet serotonin.

[Exercise therapy and bracing in patients with osteoporotic compression vertebral fractures]

Osteoporotic vertebral fractures (VF) have a negative impact on quality of life within a year after injury. A recent-onset vertebral body compression fracture in the presence of osteoporosis (OP) is generally accompanied by acute back pain, hypokinesia, and a reduction in daily physical and social activities, further leading to social isolation. Rehabilitation measures are of particular importance to restore quality of life in OP patients, especially in the people who have a history of fractures. Exercise therapy is the mainstay of management in patients with OP and VF; however, pain and limited mobility can be a barrier to exercises. Competent bracing is a method that can assist in reducing pain in VF, stabilizing the spine, and increasing motor activity. The use of an orthosis not only improves quality of life, but also gives an opportunity to take physical exercises. Semi-rigid and elastic corsets are preferable to rigid structures that are less convenient to use and associated with a large number of undesirable phenomena. Wearing a brace continuously (with its obligatory taking off overnight) is rational for 6-8 weeks. Above this period, there is an increased risk of muscle atrophy. It is acceptable to longer use orthoses situationally, if there is a need to be in an upright position, during long walks, trips, or physical exercises.

International register “Analysis of Chronic Non-infectious Diseases Dynamics After COVID-19 Infection in Adult Patients (ACTIV SARS-CoV-2)”

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[The effect of basic therapy with calcium and vitamins D3 and B6 on muscle strength, movement and balance functions at patients with osteoporosis undergoing medical rehabilitation]

AIM

Study of the effect of taking a complex biologically active food supplement with calcium and vitamins D₃ and B₆ to the effectiveness and duration of medical rehabilitation effect at patients with osteoporosis and with a high risk of fractures.

MATERIAL AND METHODS

We examined 119 men and women with osteoporosis and (or) with a high risk of fractures, beginning a course of medical rehabilitation. The 1st study group (SG1) included 41 patients who had already received antiresorptive therapy. In SG2 and SG3, 39 patients who did not receive pathogenetic therapy of osteoporosis were included by the randomization method. For patients SG1 and SG2, a complex biologically active food supplement Osteomed forte was prescribed to use within 12 months. The dynamics of tensodynamometry, stabilometry and functional tests were evaluated in 20 days, 6 and 12 months after the start of the study.

RESULTS

The muscle strength indicators achieved during the 20-day training session compared to the initial level were maintained for 12 months in extensor and flexor of the back at patients within SG1 and SG2, as well as up to 6 months in the lateral flexor of the back at patients of SG1. At patients within SG3, the effect of medical rehabilitation completely regressed after 6 months. Higher stabilization parameters after 6 and 12 months in comparison with the initial level were observed only in patients within SG1 and SG2. The effect achieved during rehabilitation was supported for 12 months in the 'stand on one leg' test within SG1, comparing in contrast to SG3, where a deterioration in the average value of the test indicator was noted.

CONCLUSION

Long-term use of food supplements containing calcium salts with vitamins D₃ and B₆can be recommended to maintain the effect of rehabilitation measures at patients with osteoporosis and with a high risk of fractures, more preferably in combination with antiresorptive therapy.

[Nebulized budesonide in the treatment of exacerbations of chronic obstructive pulmonary disease: Efficacy, safety, and effects on the serum levels of soluble differentiation molecules]

AIM

To investigate the efficacy and safety of nebulized budesonide and systemic glucocorticosteroids (GCS) (SGCS) in the treatment of an exacerbation of chronic obstructive pulmonary disease (COPD) and their effects on the serum concentration of soluble leukocyte differentiation antigens.

MATERIALS AND METHODS

Seventy-eight hospitalized patients with an acute exacerbation of COPD were randomized into two groups: 1) 37 patients took nebulized budesonide 4 mg/day; 2) 41 patients received intravenous prednisolone. The symptoms of COPD, forced expiratory volume in one second (FEV1) and other spirometric indicators, peripheral blood oxygen saturation (SpO2), and adverse events were studied. The serum levels of the soluble adhesion molecules CD50 (sCD50) and CD54 (sCD54) and the lymphocyte activation molecules CD38 (sCD38) and CD25 (sCD25) were investigated by an enzyme immunoassay.

RESULTS

There was a significant resolution of the symptoms of COPD, FEV1, and SpO2 in both groups after treatment. The incidence of hyperglycemia episodes was lower in the budesonide group than in the sGCS group. GCSs caused a decrease in the serum level of soluble interleukin-2 receptor (sCD25) in both groups. A prednisolone cycle, unlike a budesonide one, was found to reduce the concentrations of sCD54, sCD50, and sCD38.

CONCLUSION

Nebulized budesonide is an effective and safe alternative to SGCS in treating an exacerbation of COPD. Inhaled GCSs, unlike SGCSs, exhibit anti-inflammatory activity, but exert no immunosuppressive activity.

[The role of micronutrients in the comprehensive rehabilitation of patients with the novel coronavirus infection COVID-19]

Post-COVID disorders syndrome (PCDS) is an umbrella term for a complex of persistent symptoms that a patient can develop after suffering from COVID-19. The aim of the research was to systematize data on the role of micronutrients in the treatment of PCDS. Material and methods. The authors carried out a systematic analysis of foreign (ncbi. nlm.nih.gov) and Russian (elibrary.ru) scientific publications. Results. The most common symptoms that can persist for a long time after a coronavirus infection can be divided into 4 groups: 1) hypoxic syndrome (respiratory and oxygen deficiency); 2) asthenic syndrome; 3) syndrome of neuropsychiatric disorders; 4) gastrointestinal symptoms. Adequate dietary intake of vitamins and mineral substances is critical for the proper functioning of the immune system and maintenance of the organism functional reserves. The optimal consumption of vitamins D, C and E, zinc and ω-3 fatty acids with ration can be useful for preventing infection, supporting immunity during COVID-19 disease and in the complex of rehabilitation of patients with PCDS. Conclusion. Intake of dietary supplements containing complex of micronutrients can be recommended as a rational adjuvant therapy during the rehabilitation period after COVID-19. However, further research is essential to determine the effective dosage of vitamins and other micronutrients to reduce the manifestations of PCDS.

[The problem of the use of hormonal therapy aimed for sex correction by transgender persons on their own initiative]

BACKGROUND

In recent years, the demand for feminizing and masculinizing hormone therapy has increased significantly among transgender people around the world. There are no such studies in Russia and the amount of medical information on the transgender population is limited.

AIM

to assess the number of transgender patients who take hormone therapy without a doctor's prescription and to characterize the medicines they use.

MATERIALS AND METHODS

data from 1117 transgender patients were included in to analysis: 44.01% (n=515) of them were trans women, 55.99% (n=630) were trans men. Patients applied to the "Scientific Center for Personalized Medicine" in order to receive medical care.

RESULTS

Half of transgender people (53.6%) are already taking hormonal drugs. More often transgender women (76.7%), less often transgender men (32.3%). In this case, only 8.6% turned to endocrinologists for the therapy prescription. Many patients used unlicensed drugs, use irrational schemes and combinations, often overdose.

CONCLUSION

A significant number of transgender people start using hormone replacement therapy on their own initiative, without the doctor's supervision. The solution to this problem could be incensement of knowledge level in doctors and patients to create a friendly environment and productive interaction between therapists, endocrinologists and transgender people, as well as the organization of consulting centers within public medical institutions.

[The effect of administration of dietary supplement with calcium and vitamins D3 and B6 on calcium homeostasis and falls incidence in patients with high fracture risk undergoing medical rehabilitation]

Elimination of vitamin D and calcium deficiencies is of particular importance in older patients undergoing medical rehabilitation after a serious illness, surgery or injury and having a high risk of fractures. Preventing falls and fractures, including during the course of rehabilitation, is an important challenge that can be addressed in these patients, in particular through improved nutrition and vitamin D and calcium supplementation. The aim of the study was to evaluate the effect of long-term intake of a complex dietary supplement with calcium and vitamins D₃ and B₆ on calcium homeostasis and the frequency of falls in patients with high fracture risk undergoing medical rehabilitation. Material and methods. The study enrolled 109 women and 10 men (mean age 65.5±7.9 years) with high fracture risk who were undergoing medical rehabilitation. After baseline examination, 41 patients have been receiving antiresorptive therapy already comprised group 1, and patients who didn't receive osteoporotic therapy were randomized into groups 2 (n=39) and 3 (control, n=39). Patients in groups 1 and 2 for 12 months were prescribed a dietary supplement containing calcium in a daily dose of 200 mg (in the form of citrate 1000 mg), 600 IU of vitamin D₃ and 2 mg of vitamin B₆. All patients underwent assessment of bone mineral density (BMD), calculation of absolute 10-year fracture risk according to FRAX, assessment of food calcium intake, etermination of biochemical parameters of calcium-phosphorus metabolism and bone remodeling (total calcium, inorganic phosphorus, alkaline phosphatase activity - by colorimetric method in blood serum; immunoreactive parathyroid hormone (PTH) and osteocalcin - by electrochemiluminescence immunoassay in blood serum; β-isomer of C-terminal telopeptide of type I collagen (CTx) and 25(OH)D in blood plasma - by immunochemiluminescence analysis), cases of falls and fractures were fixed. Results. Average daily intake of calcium in the studied sample (n=119) was 782.9±243.4 mg, and 67.2% of patients consumed less than 800 mg of calcium daily. Vitamin D deficit was detected in 38.4% of the examined, its insufficiency - in 32.8%. An increase in 25(OH)D concentration was noted in groups 1 and 2 after 6 and 12 months (p<0.01), while in group 3 there was no dynamics of 25(OH)D (p>0.05). Patients in group 1 showed an increase in the level of osteocalcin and total calcium after 6 and 12 months, as well as alkaline phosphatase activity after 6 months (p<0.05). In group 3, there was an increase of PTH levels after 6 (p<0.05) and 12 months (p<0.01), CTx and alkaline phosphatase activity after 12 months (p<0.05). In group 1, there was an increase in BMD in the spine (+4.2%, p=0.024), femoral neck (+3.0%, p=0.041), and total femur (+2.7%, p=0.045), in patients of group 2 - an increase in BMD in the spine (+1.8%, p=0.048). In group 1, there was also a decrease in proportion of patients who fell after 6 months (χ²=4.97, p=0.026) and a decrease in the total number of falls after 12 months (χ²=4.89, p=0.027). Group 2 showed a decrease in the number of patients who fell after 6 and 12 months (χ²=48.58, p=0.0034 at both stages of the study) and the number of falls in general after 6 months (χ²=6.02, p=0.0142). Conclusion. The obtained data allow us to recommend prescription of dietary supplements containing calcium and vitamin D₃ as a part of complex rehabilitation of patients with high fracture risk.

[The suicidal activity and comorbid mental pathology in persons with gender dystrophia]

According to foreign publications, 58% of patients with gender disorders had additional psychiatric diagnosis, 39.3% had at least one suicide attempt. The data of suicidal activity and mental comorbidity in Russian population of transgenders are absent.Purpose of the study is to assess suicidal activity and mental comorbidity in persons with gender disorders.The retrospective analysis of records of patients applied with complains on gender disorders from January 2014 to April 2021 was applied. The demographic characteristics, life anamnesis, comorbid mental pathology at time of appliance, frequency of suicidal attempts, suicidal thoughts and auto-aggressive behavior were examined. The data of 926 patients with gender disorders were included: FtM 515 (55.7%), MtF 411 (44.3%). The median age of patients applied for care appliance was 24 years (13-65 years). In group of transgender patients 75.2% had no mental illness, except gender disorders. At that, there was high prevalence of comorbid mental pathology (24.8% on average). Usually, it was background mental illnesses and reversible mental disorders, which were not causes of gender disorders. The suicide rate in transgender group was 12.5%. For 1 patient with suicidal experience, there were 1.3 suicidal attempts (from 1 to 5). The significant dependence of increased suicidal activity, depression, auto-aggressive behavior and rate of comorbid mental pathology on age of debut of gender disorders was established. The transgender patients with debut of gender dysphoria in puberty age are most vulnerable to development of any mental pathology. The suicidal activity of patients with gender disorders depends on both social causes and presence of comorbid mental pathology. A number of modifiable risk factors for suicidal behavior were identified: support of relatives, external correspondence to associated gender, early steps to "change gender", earlier apply for medical care, background compensated mental illnesses.

[Effect of long-term antihypertensive therapy on vaso-regulating function of the brachial artery in patients with arterial hypertension associated with type 2 diabetes mellitus]

AIM

To evaluate the impact of 6-month-to-one-year antihypertensive therapy on the vasoregulating junction of the brachial artery and predictors of its efficiency in 75 patients with stages I-II arterial hypertension associated with type 2 diabetes mellitus.

MATERIALS AND METHODS

An open randomized study of parallel groups of patients receiving angiotensin-converting enzyme (ACE) inhibitors, calcium blockers (verapamil) and their combination and in those who did not take antihypertensive therapy examined endothelium-dependent vasodilation (EDVD) according to the data of ultrasound scanning and Doppler study of brachial arterial blood flow as compared with changes in metabolism and 24-hour blood pressure profile.

RESULTS

A positive effect of verapamil on the baseline impaired EDVD is realized only in the presence of an adequate compensation of glycemia, at the normal blood level of cortisol, occurs in parallel with increased nonendothelium-dependent vasoreactivity, and associates with the magnitude of an antihypertensive effect. ACE inhibitors improve decreased EDVD irrespective of the degree of glycemic control, the blood level of cortisol without a clear correlation with the altered non-endothelium-dependent vasoreactivity and with the degree of an antihypertensive effect. Combined therapy with these agents causes decreases in baseline insulinemia and the athoregenicity index and it can improve impaired vasoreactivity even in case of incomplete antihypertensive therapeutic effect.

CONCLUSION

The differences found in the effect of ACE inhibitors and verapamil on baseline decreased EDVD provide evidence for differential use of these drugs to correct impaired vasoreactivity in patients with AH associated with DM. The combined antihypertensive therapy fails to produce a positive impact if significant hypercholesterolemia (total blood cholesterol being more than 6.5 mmol/l) and stenosing peripheral atherosclerosis are present.

Modern ideas about the origin, features of morphology, prognostic and predictive significance of tumor vessels

The review presents modern ideas about the origin of tumor vessels and the features of their morphology. The various approaches to the classification of tumor vessel types and to the assessment of their clinical and prognostic significance are described. Also, the main problems associated with the use of angiogenesis blockers in the treatment of malignancies and their possible solutions are reflected in the review.

[Use of the syrup prepared on the basis of wild-growing grasses of the Far East, in preventive maintenance of respiratory diseases and microelementoza at children]

Working out formula and techology of producing the syrup, which is based on herbs of Far Eastern Region (dog rose; leaves of currant, lime-tree; herbs St. John's wort, parsley. Nettle; licorice) and food dietary supplements--Laminal (the product of processing of brown seaweeds). Here are the results of the research work of chemical contents, energetic value, minor componential contents and microbiological values of syrup. The results of approbation of the syrup on the group of children (who catch a cold very often) showed the increase of coefficient of special immune lymphocytic-monocytical and cell-phagocytal protection. These results allow us to recommend it as a kind of treatment, included in health-improvement program.

[The cognitive status and aspects of life quality of the Russian researchers]

The publications analysis confirms necessity of studying both status of cognitive capacities of researchers and factors associated with cognitive aging.

THE PURPOSE OF THE STUDY

To assess cognitive functions and quality of life of researchers of state institutions.

MATERIALS AND METHODS

The single-stage section of state institutions was applied to arrange sampling of 53 researchers (28 females and 25 males) aged from 22 to 73 years. The respondents filled questionnaires "Cognitive screening", "Age is not a drawback", "Depression Geriatric Scale", "Russian validated version of QOL questionnaire SF-36".

RESULTS

As in general population, among researchers certain decrease in quality of life with age was established. The respondents aged from 50 to 59 years demonstrated lower indices on scales of physical functioning (p = 0.04), body pain (p = 0.03) and role functioning due to physical condition (p = 0.006). At that, indices of vital activity and social functioning tended to improvement with age. The cognitive impairments were absent in 96.23% of researchers aged from 22 to 73 years and they were present in 1.89% of respondents. In 47.17% of respondents aged from 22 to 67 years, no senile asthenia syndrome was observed. The preasthenia was registered in 39.62% of respondents aged from 24 to 69 years. The syndrome of senile asthenia was established in 11.32% of respondents aged 25-73 years. The depression was absent in 83.02% of respondents aged from 22 to 69 years and it was probably present in 7.55% of respondents aged from 25 to 33 and 49 years.

CONCLUSION

According to data of complex screening self-testing, it is established that current state of researchers is characterized by availability of complex of problems related to health disorders, decreased cognitive functions, development of premature aging syndrome and presence of significant number of risk factors of health disorders due to high frequency and combination of these factors. The relationship between cognitive functions and quality of life of researchers is established, in particular, according to scales "Physical functioning", "General health", "Vitality", "Social functioning", "Mental health".

[The serotonin content in human platelets is unstable: data and possible mechanisms]

The study of serotonin content in platelets showed the instability of this trait and its interrelation with plasma serotonin. The oscillations of platelet serotonin are stabilized by the removing of plasma proteins, calcium and by incubation with lithium. The model of synchronization of serotonin transport via the membrane of platelets bound into a spongy net by fibrinogen molecules is discussed.

[Methods for quality of life assessment in children with orphanic diseases]

Orphan (rare) diseases include congenital or acquired diseases, the frequency of occurrence of which does not exceed a certain number established by the laws of various countries. Despite its rarity, the orphan diseases make a significant contribution to the structure of population disability and most of them have no specific treatment. One of the main clinical challenges in these patients is to ensure their high quality of life (QOL). The review describes basic non-specific and specific questionnaires for assessing QOL in children with orphan diseases. An ideal questionnaire for assessing QOL in children with orphan disease should be sufficiently reliable, valid, sensitive and specific, fill out by a child or adolescents on their own, include questions covering as much as possible all areas of life and health aspects - especially those associated with the main decease. The questionnaire should not be too huge and complicated for the patient. From the side of the researcher, the simplicity of the tool in calculating and the ability to use the results for subsequent analysis are important.