Тяжелые респираторные осложнения как причина неблагоприятного исхода при гриппе А (H1N1sw2009) у больных с ожирением

Summary. Thirty three medical records and postmortem examination reports of patients died from influenza A virus (H1N1sw2009) in October and November, 2009, in the Transbaikal Territory were analyzed. The patients were divided into two groups. The first group consisted of 22 patients with obesity and the second group consisted of 11 patients with normal body weight. There was no difference between the groups in age, gender structure, and duration of the disease. Causes of death were pneumonia and progressive respiratory failure. The rate of acute respiratory distress syndrome was similar in both the groups. Thrombosis of various locations was seen more often in obese patients. A tendency was found to a higher rate of rhabdomyolisis, acute canalicular necrosis and intravascular coagulation blood syndrome in obese patients. Additional risk factors in those patients were diabetes mellitus, pancreatitis, and hypertension. Possible reasons of severe course of influenza A virus (H1N1sw2009) infection in obese patients, such as alveolar hypoventilation, production of proinflammatory cytokines by the fat tissue resulting in poor immune response, coagulation and metabolic disorders have been discussed in the article. All these conditions were responsible for complications and exacerbations of concomitant diseases but could not justify high mortality rate in this pandemic influenza A virus infection. The severe course of the infection may be attributable to virus A (H1N1sw2009) ability to damage the mitochondrial protein PB1-F2 and intervene into the fat exchange. Thus, obesity was the most considerable risk factor for death during influenza A virus (H1N1sw2009) outbreak in the Transbaikal Territory due to aggravation of underlying metabolic disorders by specific effects of pandemic influenza virus A strain.Резюме. Были проанализированы 33 истории болезни и протоколы вскрытий пациентов, умерших от гриппа А (H1N1sw2009) в октябре–ноябре 2009 г. в Забайкальском крае. Выделены 2 группы. Первая состояла из 22 человек, имеющих ожирение, вторая была сформирована из оставшихся 11 лиц с нормальным весом. В группах сравнения не получили разницы по возрастной и половой структуре, а также по длительности болезни. Все пациенты умерли от пневмонии и прогрессирующей дыхательной недостаточности. С одинаковой частотой развивался острый респираторный дистресс-синдром. У пациентов с избыточным весом достоверно чаще формировались тромбозы различных локализаций, имелась тенденция к более частому развитию рабдомиолиза, острого канальцевого некроза, синдрома внутрисосудистого свертывания крови. Среди дополнительных факторов риска в этой категории умерших чаще диагностировался сахарный диабет, панкреатит, артериальная гипертензия. В статье обсуждаются возможные причины тяжелого течения гриппа А (H1N1sw2009) у больных с избыточным весом: альвеолярная гиповентиляция, продукция жировой тканью провоспалительных цитокинов, ведущих к нарушению в иммунном ответе, в свертывающей системе крови, в метаболическом статусе, которые обусловили регистрируемые осложнения и сопутствующие заболевания, однако не объяснили высокую смертность именно при пандемическом гриппе. Причиной тяжелого течения инфекции, вероятно, послужила способность вируса А (H1N1sw2009) вмешиваться в жировой обмен за счет повреждения митохондрий с помощью белка PB1-F2. Таким образом, ожирение стало наиболее значимым фактором риска смерти при гриппе А (H1N1) в Забайкальском крае ввиду взаимно отягощающего влияния метаболических сдвигов, происходящих при ожирении, и особенностей пандемического штамма вируса гриппа

Risk of Developing Severe Alimentary-Constitutional Obesity and Metabolic Disorders: Interventional Comparative Study

Background. The relevance of alimentary-constitutional obesity, especially its severe forms, is associated with a number of metabolic disorders, subsequently leading to serious chronic noncommunicable diseases.Objective. To identify factors that increase the risk of severe alimentary-constitutional obesity and metabolic disorders.Methods. A follow-up group of 426 patients aged 18 to 65 years was formed among those seeking help from an endocrinologist for overweight or obesity. The diagnosis of alimentary-constitutional obesity was confirmed at the initial examination in the outpatient clinic setting. Depending on the severity of obesity and the type of fat deposition according to anthropometric data (body mass index, waist circumference), the study participants were ratified into two study groups. The research was conducted between 2010 and 2017 in outpatient settings and was based on a cross-sectional comparative study. In order to assess the risk of severe obesity and factors associated with it, the authors studied medical history data, results of physical examination, including blood pressure level, laboratory examination with analysis of carbohydrate, fat metabolism and liver function, assessed eating behaviour, and performed diagnosis of anxiety-depressive disorder. Statistical analysis of the results was carried out using Statistica 10 (StatSoft, USA).Results. Women are more likely to see an endocrinologist with less severe obesity than men. Severe obesity risk is higher in middle-aged and elderly people, as well as in hereditary tainted patients and those having a history of obesity for more than 10 years. Severe obesity itself is a significant risk for metabolic events, with a 4-fold higher risk of hyperglycaemia and hypercholesterolaemia (due to very low density lipoproteins) and a 5-fold higher risk of hyperinsulinaemia and insulin resistance.Conclusion. Analysis of severe obesity risks has shown that earlier personal commitment to a healthy lifestyle is essential for weight loss and subsequent improvement of metabolic parameters, particularly in men and those aged 45 years or older

Организация медицинской помощи больным с тяжелыми пневмониями на фоне гриппа А/H1N1

The paper describes the way medical and intensive cares are organized to patients with complicated forms of A/H1N1 and seasonal influenzas in the Trans-Baikal Territory in the fall of 2009.В статье приведены особенности организации медицинской помощи и интенсивной терапии больным с осложненными формами гриппа A/H1N1/09 и сезонного гриппа в Забайкальском крае осенью 2009 года

Clinical features of post-COVID-19 period. Results of the international register “Dynamic analysis of comorbidities in SARS-CoV-2 survivors (AKTIV SARS-CoV-2)”. Data from 6-month follow-up

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 Relationship of Endothelial Dysfunction with the Development of Diastolic Heart Failure in Patients with Hypertension

Aim. To identify genetic predictors of diastolic dysfunction and signs of endothelial dysfunction in relation to indicators of left ventricular myocardial deformity in patients with hypertension.Material and methods. The study included 74 patients (38 women and 36 men) with hypertension 1-2 stages observed in the cardiology department of the Road clinical hospital at Chita II station. The mean age of patients was 32±9.4 years. Circulating endothelial cells (CEC) were determined by flow cytometry with BT 5000 device and antibodies to CD146+, CD45. Besides, 7AAD ion dye was used to detect living and dead endothelial cells. The number of CD146+, CD45 cells per 500000 blood cells was determined. Changes in CEC, Living/Dead CEC were studied. The data was processed using CXP Cytometer and Kaluza programs. The standard echocardiography, Doppler echocardiography and tissue Doppler echocardiography were used. Frequency distribution of alleles and genotypes: 1 mutation nitric oxide synthase 3 gene NOS3 -786 T>C; (С-786Т) in relation to indicators of left ventricular myocardial deformity was analyzed in hypertensive patients with or without diastolic dysfunction as well as in the control group. Polymerase chain reaction with detection of amplification product in real time (RCR-rt) or electrophoresis in agarose gel on genomic DNA of peripheral blood leukocytes were used for studying gene mutations.Results. Development of diastolic dysfunction in hypertensive patients enhanced with the carrier of the genotype NOS3 -786 CC (р=0.01 2, x2=1 2.53), endothelial dysfunction was manifested by an increase in the number of circulating endotheliocytes and was associated with a decrease in global longitudinal deformation of the left ventricle.Conclusion. Endothelial dysfunction in patients with hypertension is associated with a violation of global longitudinal deformation; and in patients with diastolic dysfunction these abnormalities are more pronounced than in patients without diastolic dysfunction

CHANGES IN PLASMA LIPID COMPOSITION IN PATIENTS WITH ESSENTIAL HYPERTENSION

To examine the relation between serum fatty acids, blood pressure and heart failure in hypertensive patients we conducted a study of 58 patients with essential hypertension (mean age 45,1 ± 9,4 years) and 22 healthy subjects. It was established, that in essential hypertension the levels of saturated and monounsaturated fatty acids increased and the amount of polyunsaturated fatty acids decreased. Aforesaid changes were different within some classes of fatty acids: among saturated acids the levels of myristic and palmitic acids increased and the concentration of stearic acid decreased. Among polyunsaturated acids the amount oflinolenic and a-linolenic acids decreased and the level of arachidonic acid increased. Aforesaid changes correlated with main parameters of ambulatory blood pressure monitoring and structural and functional state of left ventricle

Blood and Urinary Biomarkers of Antipsychotic-Induced Metabolic Syndrome

Metabolic syndrome (MetS) is a clustering of at least three of the following five medical conditions: abdominal obesity, high blood pressure, high blood sugar, high serum triglycerides, and low serum high-density lipoprotein (HDL). Antipsychotic (AP)-induced MetS (AIMetS) is the most common adverse drug reaction (ADR) of psychiatric pharmacotherapy. Herein, we review the results of studies of blood (serum and plasma) and urinary biomarkers as predictors of AIMetS in patients with schizophrenia (Sch). We reviewed 1440 studies examining 38 blood and 19 urinary metabolic biomarkers, including urinary indicators involved in the development of AIMetS. Among the results, only positive associations were revealed. However, at present, it should be recognized that there is no consensus on the role of any particular urinary biomarker of AIMetS. Evaluation of urinary biomarkers of the development of MetS and AIMetS, as one of the most common concomitant pathological conditions in the treatment of patients with psychiatric disorders, may provide a key to the development of strategies for personalized prevention and treatment of the condition, which is considered a complication of AP therapy for Sch in clinical practice

International register “Dynamics analysis of comorbidities in SARS-CoV-2 survivors” (AKTIV SARS-CoV-2): analysis of predictors of short-term adverse outcomes in COVID-19

The international AKTIV register presents a detailed description of out- and inpatients with COVID-19 in the Eurasian region. It was found that hospitalized patients had more comorbidities. In addition, these patients were older and there were more men than among outpatients. Among the traditional risk factors, obesity and hypertension had a significant negative effect on prognosis, which was more significant for patients 60 years of age and older. Among comorbidities, CVDs had the maximum negative effect on prognosis, and this effect was more significant for patients 60 years of age and older. Among other comorbidities, type 2 and 1 diabetes, chronic kidney disease, chronic obstructive pulmonary disease, cancer and anemia had a negative impact on the prognosis. This effect was also more significant (with the exception of type 1 diabetes) for patients 60 years and older. The death risk in patients with COVID-19 depended on the severity and type of multimorbidity. Clusters of diseases typical for deceased patients were identified and their impact on prognosis was determined. The most unfavorable was a cluster of 4 diseases, including hypertension, coronary artery disease, heart failure, and diabetes mellitus. The data obtained should be taken into account when planning measures for prevention (vaccination priority groups), treatment and rehabilitation of COVID-19 survivors

International register “Dynamics analysis of comorbidities in SARS-CoV-2 survivors” (AKTIV) and the register “Analysis of hospitalizations of comorbid patients infected during the second wave of SARS-CoV-2 outbreak” (AKTIV 2)

The organizer of the registers “Dynamics analysis of comorbidities in SARSCoV-2 survivors” (AKTIV) and “Analysis of hospitalizations of comorbid patients infected during the second wave of SARS-CoV-2 outbreak” (AKTIV 2) is the Eurasian Association of Therapists (EAT). Currently, there are no clinical registries in the Eurasian region designed to collect and analyze information on long-term outcomes of COVID-19 survivors with comorbid conditions. The aim of the register is to assess the impact of a novel coronavirus infection on long-term course of chronic non-communicable diseases 3, 6, 12 months after recovery, as well as to obtain information on the effect of comorbidity on the severity of COVID-19. Analysis of hospitalized patients of a possible second wave is planned for register “AKTIV 2”. To achieve this goal, the register will include men and women over 18 years of age diagnosed with COVID-19 who are treated in a hospital or in outpatient basis. The register includes 25 centers in 5 federal districts of the Russian Federation, centers in the Republic of Armenia, the Republic of Kazakhstan, the Republic of Kyrgyzstan, the Republic of Belarus, the Republic of Moldova, and the Republic of Uzbekistan. The estimated capacity of the register is 5400 patients

Lipid profile in hospitalized patients with COVID-19 depending on the outcome of its acute phase: data from the international registry "Dynamics analysis of comorbidities in SARS-CoV-2 infection survivors"

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