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

Efficacy of the combined therapy with etanercept and methotrexat at the female patient with generalized pustular psoriasis and arthritis psoriasis after the therapeutic failure of two the TNF-α receptor inhibitors. Case study

The article presents the clinical observation effectiveness of TNF-a inhibitor etanercept in patients with generalized pustular psoriasis and PsA, resistant to treatment by other drugs of this class. It presents the current recommendations for the management of patients with pustular psoriasis

BIOMARKERS ROLE IN THE DEVELOPMENT OF SINUS NODE DYSFUNCTION

Aim. In patients with different types of sinus node dysfunction (SND), to study inflammation marker levels and assess their value as predictors of SND development. Material and methods. The study included 83 individuals: 63 patients with SND (the main group) and 20 controls. The main group was divided into three subgroups: Subgroup 1, with vegetative SND (VSND); Subgroup 2, with Type I and II sick sinus syndrome (SSS); and Subgroup 3, with tachy-brady syndrome, or Type III SSS. In all participants, the measurement of serum levels of inflammation markers, cardiac electrophysiological testing, and long-term electrocardiography monitoring were performed. The inflammation markers of interest included tumour necrosis factor alpha (THF-α), interleukin (IL) 6, IL-4, C-reactive protein (CRP), and fibrinogen. Results. Compared to controls, SND patients were characterised by increased levels of TNF-α and IL-6. TNF-α concentration was linked to SND type, with the highest levels observed in patients with tachy-brady syndrome. Elevated levels of inflammation markers independently predicted SND development. In particular, VSND risk was 2,5 times higher in patients with IL-6 concentration >3 pg/ml. SSS risk doubled when the levels of IL-6 increased from 2,5 pg/ml to 4 pg/ml. TNF-α levels >16 pg/ml were associated with a 1,5-fold increase in the risk of Type I-II SSS transformation into tachy-brady syndrome. Conclusion. Increased expression of inflammation cytokines in SND patients could be directly linked to pathogenetic mechanisms of this arrhythmic syndrome

Seromarkers of synthesis and collagen degradation, electrophysiological heart parameters among patients with syndrome of preexcitation of ventricles

The results of examination of 43 patients withsyndrome of preexcitation of ventricles are introducedin the article. The aim of the studywas to optimize diagnostics and prediction of the developmentof arrhythmia in this cohort and to find out thepossible role of disorder of fibrous matrix in the developmentof disorder of cardiac arrhythmias. The main groupconsisted of 43 patients with syndrome of preexcitationof ventricles (phenomenon WPW, syndrome WPW) and15 practically healthy people of the same age were in thegroup of comparison. The average age of the examinedpatients from the main group was 25,3±9,15 years old,among them 29 men (67%) and 14 women (33%). Theaverage age in the comparison group was 27,9±7,9 yearsold. All groups included into the examination were comparableby gender distribution (р=0,45, Fisher’s test) andby age (р=0,27, U-criterion). The highest figures of matrixmetal proteinase-9 (MMP-9) were found among patientswith syndrome WPW – 96,1±33,2ng/ml and in the groupof phenomenon WPW (54,3±21,8ng/ml; р=0,0003). Practicallyhealthy people had minimal values of the MMP-9 -27,4±10,9ng/ml (р=0,00014; р=0,000002). Maximal valuesof tissue inhibitor of matrix metal proteinase (TIMP-1)are introduced in the group of phenomenon WPW and inthe group of practically healthy people (418,5±69,8 ng/mland 461,7±72,2ng/ml; р=0,27). Patients with syndromeWPW have lower TIMP-1 – 341,1±90,1 ng/ml (р=0,002;р=0,00012). The level of propeptideprocollagenof thetype I(PICP) among patients with syndrome WPW was179,9±76,2ng/ml and 97,8±31,7 ng/ml (р=0,00014) inthe group of phenomenon WPW. All examined patientsaccording to the level of PICP differed from practicallyhealthy people 69,4±23,9ng/ml (р<0,05, U-criterion).The examined patients have changes of fibrous matrix.That includes an increasing the concentration of MMP-9,PICP and reducing TIMP-1. The syndrome WPW is characterizedby more expressed disbalanceof seromarkers ofsynthesis and collagen degradation than phenomenon is.It is possible that the examined seromarkers of fibrosistake place in forming disorders of cardiac arrhythmias inactual syndromes

Seromarkers of synthesis and collagen degradation, electrophysiological heart parameters among patients with syndrome of preexcitation of ventricles

The results of examination of 43 patients withsyndrome of preexcitation of ventricles are introducedin the article. The aim of the studywas to optimize diagnostics and prediction of the developmentof arrhythmia in this cohort and to find out thepossible role of disorder of fibrous matrix in the developmentof disorder of cardiac arrhythmias. The main groupconsisted of 43 patients with syndrome of preexcitationof ventricles (phenomenon WPW, syndrome WPW) and15 practically healthy people of the same age were in thegroup of comparison. The average age of the examinedpatients from the main group was 25,3±9,15 years old,among them 29 men (67%) and 14 women (33%). Theaverage age in the comparison group was 27,9±7,9 yearsold. All groups included into the examination were comparableby gender distribution (р=0,45, Fisher’s test) andby age (р=0,27, U-criterion). The highest figures of matrixmetal proteinase-9 (MMP-9) were found among patientswith syndrome WPW – 96,1±33,2ng/ml and in the groupof phenomenon WPW (54,3±21,8ng/ml; р=0,0003). Practicallyhealthy people had minimal values of the MMP-9 -27,4±10,9ng/ml (р=0,00014; р=0,000002). Maximal valuesof tissue inhibitor of matrix metal proteinase (TIMP-1)are introduced in the group of phenomenon WPW and inthe group of practically healthy people (418,5±69,8 ng/mland 461,7±72,2ng/ml; р=0,27). Patients with syndromeWPW have lower TIMP-1 – 341,1±90,1 ng/ml (р=0,002;р=0,00012). The level of propeptideprocollagenof thetype I(PICP) among patients with syndrome WPW was179,9±76,2ng/ml and 97,8±31,7 ng/ml (р=0,00014) inthe group of phenomenon WPW. All examined patientsaccording to the level of PICP differed from practicallyhealthy people 69,4±23,9ng/ml (р<0,05, U-criterion).The examined patients have changes of fibrous matrix.That includes an increasing the concentration of MMP-9,PICP and reducing TIMP-1. The syndrome WPW is characterizedby more expressed disbalanceof seromarkers ofsynthesis and collagen degradation than phenomenon is.It is possible that the examined seromarkers of fibrosistake place in forming disorders of cardiac arrhythmias inactual syndromes

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

Clinical features of post-COVID period. Results of an International Register "Dynamics Analysis of Comorbidities in SARS-CoV-2 Survivors (ACTIV SARS-CoV-2)" (12-month follow-up)

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