BackgroundPost-COVID-19 syndrome (PCS) has been increasingly recognized as an emerging problem: 50% of patients report ongoing symptoms 1 year after acute infection, with most typical manifestations (fatigue, dyspnea, psychiatric and neurological symptoms) having potentially debilitating effect. Early identification of high-risk candidates for PCS development would facilitate the optimal use of resources directed to rehabilitation of COVID-19 convalescents.ObjectiveTo study the in-hospital clinical characteristics of COVID-19 survivors presenting with self-reported PCS at 3 months and to identify the early predictors of its development.Methods221 hospitalized COVID-19 patients underwent symptoms assessment, 6-min walk test, and echocardiography pre-discharge and at 1 month; presence of PCS was assessed 3 months after discharge. Unsupervised machine learning was used to build a SANN-based binary classification model of PCS development.ResultsPCS at 3 months has been detected in 75% patients. Higher symptoms level in the PCS group was not associated with worse physical functional recovery or significant echocardiographic changes. Despite identification of a set of pre-discharge predictors, inclusion of parameters obtained at 1 month proved necessary to obtain a high accuracy model of PCS development, with inputs list including age, sex, in-hospital levels of CRP, eGFR and need for oxygen supplementation, and level of post-exertional symptoms at 1 month after discharge (fatigue and dyspnea in 6MWT and MRC Dyspnea score).ConclusionHospitalized COVID-19 survivors at 3 months were characterized by 75% prevalence of PCS, the development of which could be predicted with an 89% accuracy using the derived neural network-based classification model.

The main cardiovascular diseases affect the processes of myocardial remodeling, which further contributes to the formation of systolic or diastolic heart dysfunction. The formation of myocardial dysfunction is primarily associated with left ventricular hypertrophy when under hemodynamic loading, firstly, wall rigidity increases, secondly, myocardial fibrosis is formed. The latter is one of the key factors of the hypertrophic process caused by the accumulation of collagen, which leads to a aggravation of the left ventricle relaxation processes. Cardiac remodeling is defined as a group of molecular, cellular, and interstitial changes that are clinically manifested by alterations in the size, shape, and function of heart as a result of the heart muscle injury. It has been determined that fibrosis is an early morphological sign of injury in patients with left ventricular overload, as well as a factor in the development of diastolic and systolic dysfunctions. Compensatory left ventricular hypertrophy transforms into heart failure due to the fibrosis development. In hypertrophy the content of elastic collagen type III decreases and rigid collagen type I increases. The essential role of the extracellular matrix in myocardial fibrosis formation is emphasized. Cardiac fibrosis is a process of pathological remodeling of the extracellular matrix, which leads to abnormalities in its composition and dysfunction of the heart muscle. The extracellular matrix plays a key role in organogenesis and post−traumatic healing in tissue injuries. The study of intercellular interactions of the extracellular matrix will provide a better understanding of the mechanisms of changes in geometry and function of the heart, and investigation of the activity of matrix components will open new opportunities for targeted therapeutic effects on molecular mechanisms of cardiac remodeling. Key words: diastolic dysfunction, extracellular matrix, myocardial fibrosis, cardiomyocytes, fibroblasts.

Over a long period, chronic heart failure was primarily associated with impaired contractility of the left ventricular myocardium, which is a manifestation of systolic dysfunction. Based on modern ideas about the pathophysiology of CHF syndrome, systolic dysfunction is considered as one of the etiological factors along with changes in wall tension and the structure of diastolic filling, i.e. everything that is included in the concept of “LV remodeling”. The objective is to present a review of the key parameters of chronic heart failure and left ventricular diastolic dysfunction according to the latest updates. The role and significance of diastolic dysfunction as the cause of chronic heart failure syndrome have only been determined over the past three decades, which can be explained by the difficulty of early diagnostics of diastolic dysfunction. The article describes the historical evolution of heart failure and left ventricular diastolic dysfunction estimation. It is important to note the high prevalence of diastolic dysfunction. The signs of myocardial diastolic dysfunction are detected in people with almost any heart disease. The universal review of the most important parameters which determine this disorder has been presented. It has been shown that Doppler echocardiography is now the noninvasive “gold standard” for estimation of diastolic dysfunction. We have presented methods of treatment for diastolic dysfunction according to the 2017AmericanCollegeof Cardiology/American Heart Association updated Guidelines for the management of heart failure Conclusions. The experimental studies demonstrate that the survival of HF patients with a preserved EF depends not so much on its indices, but on the severity of DD. DD is a more prognostic marker of mortality rate in patients with HF than EF, which requires further study for better therapeutic efficacy.

SUBCLINICAL CARDIAC DAMAGE IN CARDIOPULMONARY POLYMORBIDITY. (review). Part 1. Ashcheulova T., Ambrosova T., Kochubiei O., Honchar O., Sytina I. Hypertension and chronic obstructive pulmonary disease are one of the frequent comorbid conditions in internal medicine and are subject to meaningful cooperation among physicians, cardiologists, and pulmonologists. A combination of chronic obstructive pulmonary disease and hypertension presents certain diagnostic and therapeutic challenges. These conditions share common risk factors, similar clinical presentations and some common parts of pathogenesis. The problem of association between chronic obstructive pulmonary disease and hypertension may be currently discusses both as a simple combination of various clinical entities, and as chronic obstructive pulmonary disease resulting in development of factors contributing to hypertension. One way or another, either a simple combination, or a mutually aggravating syndrome, but we state there is a cardiorespiratory continuum where chronic obstructive pulmonary disease acts as a valid component of hypertension development, and vice versa. Thus, it seems to be relevant to study peculiarities of the structural and functional status of the cardiovascular system and microcirculation, systemic remodeling mechanisms, endothelial dysfunction and inflammation in presence of chronic obstructive pulmonary disease -associated hypertension. Problems of additional cardiovascular risk marker development, treatment efficiency assessment remain topical. Use of electrocardiography and echocardiography with dopplerometry has been an important diagnostic principle of subclinical cardiovascular damage in presence of hypertension and chronic obstructive pulmonary disease comorbidity. Non-invasive imaging methods play a central part in diagnostics of subclinical target organ damage. Wide implementation thereof is based on high diagnostic accuracy, common availability, safety and relatively low price. Key words: hypertension, chronic obstructive pulmonary disease, comorbidity, electrocardiography, echocardiography with dopplerometry Резюме. СУБКЛІНІЧНЕ УРАЖЕННЯ СЕРЦЯ ПРИ КАРДІОПУЛЬМОНАЛЬНІЙ ПОЛІМОРБІДНОСТІ (огляд). Частина 1. Ащеулова Т.В., Амбросова Т.М., Кочубєй О.А., Гончарь О.В., Ситіна І.В. Артеріальна гіпертензія і хронічне обструктивне захворювання легень - одне з частих коморбідних станів в клініці внутрішніх хвороб і є предметом конструктивної взаємодії терапевтів, кардіологів, пульмонологів. Поєднання хронічного обструктивного захворювання легень і артеріальної гіпертензії являє певні труднощі для діагностики і лікування. Ці захворювання мають загальні фактори ризику, схожі клінічні прояви і спільність деяких ланок патогенезу. Таким чином, представляється актуальним дослідження особливостей структурно-функціонального стану серцево-судинної системи і мікроциркуляції, вивчення системних механізмів ремоделювання, ендотеліальної дисфункції та запалення при артеріальній гіпертензії в поєднанні з хронічним обструктивним захворюванням легень. Залишаються актуальними питання розробки додаткових маркерів серцево-судинного ризику, оцінки ефективності проведеного лікування. В останні роки важливими принципами діагностики субклінічного ураження серця і судин при коморбідності хронічного обструктивного захворювання легень і артеріальної гіпертензії є використання електрокардіографії та ехокардіографії з доплерометрією. Неінвазивні методи візуалізації відіграють центральну роль в діагностиці субклінічного ураження органів-мішеней. Їх широке застосування обумовлено високою діагностичної точністю, повсюдною поширеністю, безпекою і відносно низькою вартістю. Ключові слова. Артеріальна гіпертензія, хронічне обструктивне захворювання легень, коморбідность, електрокардіографія, ехокардіографія з доплерометрією. Резюме. СУБКЛИНИЧЕСКОЕ ПОРАЖЕНИЕ СЕРДЦА ПРИ КАРДИОПУЛЬМОНАЛЬНОЙ ПОЛИМОРБИДНОСТИ (обзор). Часть 1. Ащеулова Т.В., Амбросова Т.Н., Кочубей О.А., Гончарь А.В., Сытина И.В. Артериальная гипертензия и хроническое обструктивное заболевание легких - одно из частых коморбидных состояний в клинике внутренних болезней и являются предметом конструктивного взаимодействия терапевтов, кардиологов, пульмонологов. Сочетание хронического обструктивного заболевания легких и артериальной гипертензии представляет определенные трудности для диагностики и лечения. Эти заболевания имеют общие факторы риска, схожие клинические проявления и общность некоторых звеньев патогенеза. Таким образом, представляется актуальным исследование особенностей структурно-функционального состояния сердечно-сосудистой системы и микроциркуляции, изучение системных механизмов ремоделирования, эндотелиальной дисфункции и воспаления при артериальной гипертензии в сочетании с хроническим обструктивным заболеванием легких. Остаются актуальными вопросы разработки дополнительных маркеров сердечно-сосудистого риска, оценки эффективности проводимого лечения. В последние годы важными принципами диагностики субклинического поражения сердца и сосудов при коморбидности хронического обструктивного заболевания легких и артериальной гипертензии является использование электрокардиографии и эхокардиографии с допплерометрией. Неинвазивные методы визуализации играют центральную роль в диагностике субклинического поражения органов-мишеней. Их широкое применение обусловлено высокой диагностической точностью, повсеместной распространенностью, безопасностью и относительно низкой стоимостью. Ключевые слова. Артериальная гипертензия, хроническое обструктивное заболевание легких, коморбидность, электрокардиография, эхокардиография с допплерометрией.

У статті представлено аналітичний огляд прогностичної значимості діагностики безсимптомного ураження органів-мішеней при артеріальній гіпертензії в контексті детальнішого визначення серцево-судинного ризику. Представлено основні інструментальні та функціональні проби для діагностики субклінічних стадій ураження органів-мішеней при артеріальній гіпертензії та визначено їх прогностичну значущість щодо основних кардіоваскулярних подій.

One of the main prerequisites for creation and dissemination of bioethics in the world was the concept of dual use in medical and biological sciences, which is defined as the direction of unintentional creation of biological threats in research or implementation of new biotechnologies. To determine the range of dual-use research that could potentially generate products, technologies, or knowledge whose misuse could harm large numbers of people or the environment and that are biosafety-relevant, the international term Dual Use Research of Concern (DURC) is used. Actualization of the debate on the dilemma of dual use in biomedical sciences is due to, on the one hand, the international community's attempt to minimize the potential for destructive use of biomedical research, on the other hand, the active search for effective ways to raise awareness of their social and moral responsibility for implementation of the results of scientific developments in the field of life. This article considers the definition of terms that define the field of DURC in the context of biosafety, which in recent decades have undergone a number of semantic changes. The article also outlines the modern general concept of DURC, defines the categories by which DURC is defined, and outlines the scope of policy on the implementation of control over DURC. Informing the scientific community engaged in biomedical research about the problem issues of DURC biotechnology is a key component of biosafety. Modern biotechnology and related biosafety issues should be applied to society needs, but without compromising human and environmental safety. Systematic consideration of all these disputable questions of the dual-use dilemma with the involvement of all stakeholders will allow to form a rational biosafety policy for biotechnology.

Over a long period, chronic heart failure was primarily associated with impaired contractility of the left ventricular myocardium, which is a manifestation of systolic dysfunction. Based on modern ideas about the pathophysiology of CHF syndrome, systolic dysfunction is considered as one of the etiological factors along with changes in wall tension and the structure of diastolic filling, i.e. everything that is included in the concept of "LV remodeling". The objective is to present a review of the key parameters of chronic heart failure and left ventricular diastolic dysfunction according to the latest updates. The role and significance of diastolic dysfunction as the cause of chronic heart failure syndrome have only been determined over the past three decades, which can be explained by the difficulty of early diagnostics of diastolic dysfunction. The article describes the historical evolution of heart failure and left ventricular diastolic dysfunction estimation. It is important to note the high prevalence of diastolic dysfunction. The signs of myocardial diastolic dysfunction are detected in people with almost any heart disease. The universal review of the most important parameters which determine this disorder has been presented. It has been shown that Doppler echocardiography is now the noninvasive "gold standard" for estimation of diastolic dysfunction. We have presented methods of treatment for diastolic dysfunction according to the 2017 American College of Cardiology/American Heart Association updated Guidelines for the management of heart failure Conclusions. The experimental studies demonstrate that the survival of HF patients with a preserved EF depends not so much on its indices, but on the severity of DD. DD is a more prognostic marker of mortality rate in patients with HF than EF, which requires further study for better therapeutic efficacy.

20 patients with 2 stage AH, 1-3 obesity degree (BMI 36.25 +/- 1.01 kg/m(2)) were examined. Average age was 58.9 +/- 2.87 years. In the patients with AH associated with obesity significant antihypertensive efficacy of losartan monotherapy was found. SBP level reduced on 22.3 mm Hg, DBP - on 11.4 mmHg. Target BP levels was in 90% of patients at the end of study period. In patients with AH and concomitant obesity on the base of losartan therapy statistically significant decreasing of TNF-alpha activity on 22.44% and PAI - 1 - on 22.54% as compared with baseline were detected.

Objective: It was proposed that adipokines such as tumor necrosis factor-α (TNF-α), in addition to their role in immune response in hypertension, are involved in the development of insulin resistance and obesity. The aim of our clinical study was to assess plasma TNF-α levels, body mass, glucose, insulin, HbA1c levels, and HOMA means in hypertensive patients depend on presence of insulin resistance. Design and Methods: 67 hypertensive patients were examined by anthropometric methods (height, body mass, body mass index (BMI), waist circumference). Plasma TNF-α by ELISA, fasting glucose, insulin, HbA1c, and HOMA were measured. Results: Patients were divided into two groups depend on insulin resistance (IR) presence according to HOMA means: 1group without IR – 25 (37 ± 6%) patients with HOMA<2.77, 2 group with IR – 42 (63 ± 6%) patients with HOMA>2.77. It was found that waist circumference (98.74 ± 1.8 cm) and BMI 35.04 ± 0.88 kg/m2) in insulin resistant patients were statistically higher than in hypertensives without IR (82.0 ± 1.9 cm; 29.71 ± 1.14 kg/m2; p = 0.001, correspondingly). Plasma insulin levels (23.17 ± 2.13 μU/ml) in patients with IR was threefold as compared with patients without IR (7.28 ± 0.67 μU/ml; p = 0.001). ÍbÀñ1, means (7.52 ± 0.43% vs 5.75 ± 0.4%; p = 0.004) and HOMA (8.43 ± 1.23 vs 1.61 ± 0.14; p = 0.001) were also statistically higher in insulin resistance patients. Comparison of TNF-α levels reveals significant its elevation in insulin resistance presence (36.02 ± 3.62 pg/ml) as compared with normal insulin metabolism (17.49 ± 1.51 pg/ml; p = 0.001). In hypertensive patients with IR correlations between TNF-α and insulin r = 0.75, p = 0,001), ÍÎÌÀ (r=0.70, p = 0.001), and ÍbÀñ1 (r = 0.42, p = 0.001) were determined. Conclusions: Our results showed carbohydrates metabolism alterations in hypertensive patients related to obesity presence and TNF-α activity. Insulin resistance that revealed in 63 ± 6% patients with arterial hypertension was associated with increased TNF-α production. In insulin resistant hypertensives close relationships between TNF-α and insulin, HOMA were revealed that can suggest influence of cytokine on insulin resistance development.