Введение прямых пероральных антикоагулянтов в клиническую практику, наряду с сохранением применения антагонистов витамина К, привело к увеличению числа пациентов, поступающих на экстренные хирургические вмешательства на фоне антикоагулянтной лекарственной терапии. В отличие от плановой хирургии, ургентные ситуации требуют мгновенного принятия решений в условиях временного дефицита и конкурирующих рисков тромбоза и кровотечения. В представленной обзорной статье рассматриваются современные клинические рекомендации и ключевые исследования, посвященные периоперационному ведению данной категории больных. Особое внимание уделяется алгоритмизации подхода, основанного на стратификации срочности вмешательства, оценке геморрагического риска процедуры, фармакокинетических параметрах (время последнего приема, функция почек) и селективном применении лекарственных средств реверсии (андексанет альфа, четырехфакторный концентрат протромбинового комплекса). Анализируются данные по ведению пациентов с переломами проксимального отдела бедра, демонстрирующие возможность и безопасность раннего хирургического лечения при условии протоколизированного подхода. Освещаются нерешенные вопросы, включая отсутствие унифицированных пороговых уровней прямых пероральных антикоагулянтов для принятия решений о реверсии и неопределенность в сроках возобновления антикоагуляции после высокорисковых вмешательств. Делается вывод о необходимости перехода от эмпирических задержек операций к формализованным внутрибольничным протоколам, интегрирующим усилия хирурга, анестезиолога и смежных специалистов для минимизации осложнений и улучшения прогноза.

Aim. To assess awareness of blood pressure (BP) level, adherence to therapy and achievement of target BP in residents of Russian regions as part of the 2023 hypertension (HTN) screening campaign. Material and methods. During May 2023, 4613 participants from 23 cities of Russia took part in the screening. Participation was voluntary without restrictions on sex. All patients aged over 18 years. During screening, BP and pulse were measured three times using automatic or mechanical BP monitors, and a questionnaire about behavioral risk factors, concomitant diseases and therapy was filled out. HTN was diagnosed with systolic BP ≥140 mm Hg and/or diastolic BP ≥90 mm Hg and/or taking antihypertensive therapy (AHT). Results. The analysis included data from 4585 respondents aged 18 to 95 years with an average age of 45 [28;59] years, of which 1729 were men (37,7%). The proportion of hypertensive patients was 49,6%. Among them, 62,8% took AHT and achieved target BP in 76,6% and 45,7% with the target BP criterion <140/90 mm Hg and <130/80 mm Hg, respectively. Most patients took dual AHT (37,4%), while monotherapy and triple therapy was registered in 27,5% and 23,4%, respectively. Initiation of therapy was performed with combination AHT in 43,7% of patients with HTN and 41,4% are currently using fixed-dose combination therapy. On-demand therapy was the most common reason for skipping medications and was more common in women, while men more often cited the high drug cost and a history of adverse reactions. Among patients with HTN, home BP measurement was associated with a higher prevalence of achieving target BP as follows: 1000 (60%) vs 100 (17%), p<0,001. Conclusion. The data obtained indicate, on the one hand, a continuing insufficient level of awareness about high BP and the use of antihypertensive drugs among the population, but there is a tendency to improve the effectiveness of the treatment of hypertension, including the use of fixed-dose combinations of antihypertensive drugs.

The aim of the research was to study the frequency of occurrence of anxiety and depression in first-year medical university students in the post-holiday period.Materials and methods. The study involved 70 first-year medical university students (average age 17,9 ± 1,31 years). The study was conducted as part of a periodic medical examination of participants during the first semester (in the early post-holiday period). The Hospital Anxiety and Depression Scale (HADS) was used.Results. The analysis of the answers to the questions of the HADS anxiety subscale showed that more than a third of the survey participants (38,6%) had anxiety disorders, of which more than half of the participants (51,9%) needed the advice of a clinical psychologist or psychotherapist. 21,4% of participants had a feeling of tension, 27,2% - fear, 24,3% - restless thoughts, 17,1% - inability to relax, 22,8% - internal tension or trembling, 40% - restlessness, 31,4% - panic. Analysis of answers to questions on the HADS depression subscale indicated that 22,9% of students had depressive disorders, of which more than a third (37,5%) needed the advice of a clinical psychologist or psychotherapist. 27,1% of participants had a decrease/lack of pleasure from something that used to bring positive emotions, 10% - inability to laugh, 15,7% - lack of a sense of cheerfulness, 20% - slowness, 15,7% - unwillingness to monitor their appearance, 18,6% - decreased sense of satisfaction from hobbies, 20% - decreased feelings of pleasure from a good book, radio or TV program.Conclusion. The expansion of the standard scope of periodic medical examination made it possible to screen the psycho-emotional state of students in the post-holiday period of the autumn semester and identify a risk group for the development and increase of existing anxiety-depressive disorders during the educational process, which can have an adverse effect on both the quality of life of students and the effectiveness and success of training.

Aim. To present data from the AURA Registry (real-world data registry on AlbUminuRia detection rate among patients with previously undiAgnosed chronic kidney disease). It is important to perform population studies both to study the occurrence of markers (albuminuria (AU), decreased glomerular filtration rate (GFR)) and the prevalence of chronic kidney disease (CKD), which will provide information on the actual detection rate of CKD and the related markers in territories included in the registry of research centers.Material and methods. The article presents the first data from the AURA registry. Recruitment was carried out from March 6, 2023 to January 23, 2024. Thirty-four research centers in various federal districts of the Russian Federation and 104 doctors took part in the recruitment. We included 4580 subjects over the age of 40 years who had no previously established diagnosis of CKD and did not have type 1 or type 2 diabetes. During recruitment, the researchers were guided by the AURA study protocol (Version 1.7/12-26-2022).Results. AU more than 20 mg/g was detected in 64,9% of cases. At the same time, AU is more common at GFR values that may correspond to stage 3A of CKD. The rarer occurrence of AU in those examined with GFR >60 ml/min/1,73 m2 may be explained by less severe renal damage at this CKD stage. The incidence of AU was significantly higher in men, older people, smokers, people with metabolic syndrome, hypertension (HTN), prediabetes and overweight. The occurrence of AU also increased as HTN grade increased. AU detection rate was associated with hypertriglyceridemia, a high blood level of C-reactive protein, which is an integrative marker of inflammation that negatively affects cardiovascular risk.Conclusion. The presented first data from the AURA registry demonstrated the high AU prevalence in people over 40 years of age. A high incidence of AU was typical for patients with HTN, coronary artery disease, atrial fibrillation, heart failure, and prediabetes. An association has been demonstrated between the high incidence of AU and male sex, age, overweight, hyperuricemia, dyslipidemia, and a number of other cardiovascular risk factors.

Aim . To analyze newly diagnosed diseases and features of the post-COVID course in patients after a coronavirus disease 2019 (COVID-19) within 12-month follow-up. Material and methods . A total of 9364 consecutively hospitalized patients were included in the 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 the ACTIV registry, 18,1% of patients after COVID-19 had newly diagnosed diseases (NDDs) over the next 12 months. Hypertension (HTN), type 2 diabetes and coronary artery disease (CAD) prevailed in the NDD structure. Comparison of the age-standardized incidence of NDDs (HTN, CAD, diabetes) in the post-COVID period in the ACTIV registry with NDD incidence in 2019 according to Rosstat and the expected incidence of NDDs according to the EPOHA study revealed that HTN, diabetes, CAD in patients after COVID-19 were registered more often as follows: HTN by 7,0 and 4,4 times, diabetes by 7,3 and 8,8 times, CAD by 2,3 and 2,9 times, respectively. NDDs most often developed in patients aged 47 to 70 years. Comparison of the actual and expected number of cases of newly diagnosed HTN, CAD and diabetes depending on age showed that the actual number of cases in the population of patients in the ACTIV register is significantly higher than expected for patients aged 45-69 years and for patients with hypertension or diabetes and aged <45 years. Patients with NDDs, compared with patients without NDDs, had a more severe acute COVID-19 course. Statistically significant independent predictors of NDD occurrence (HTN and/or diabetes and/or CAD) within 1 year after hospital discharge were age (direct relationship), body mass index (direct relationship) and glucose levels upon admission to hospital (direct relationship). Conclusion . Available evidence suggests that a strategy for managing COVID-19 survivors should include mandatory screening for early detection of cardiovascular disease and diabetes, which will be key to reducing the risk of further COVID-19 consequences.

Antidepressants (ADs) include drugs of various pharmacological groups, which are mainly used for the treatment of mental disorders (major depressive disorder, obsessive-compulsive disorder, social phobia, panic disorder, generalized anxiety disorder, post-traumatic stress disorder), chronic pain and addiction diseases. Chronic use of ADs can lead to the development of cardiotoxic adverse drug reactions (ADRs). The most important cardiotoxic AD-induced ADRs are prolongation of the QT interval, ventricular tachycardia of the "pirouette" type (Torsades de Pointes - TdP). This narrative review analyzes and summarizes the results of studies on pharmacokinecis and pharmacogenetics of ADs on QT interval prolongation and updates physicians' knowledge of the risk of developing AD-induced TdP in patients with psychiatric disorders.

BACKGROUND. There is enough evidence of the negative impact of excess weight on the formation and progression of res piratory pathology. Given the continuing SARS-CoV-2 pandemic, it is relevant to determine the relationship between body mass index (BMI) and the clinical features of the novel coronavirus infection (NCI). AIM. To study the effect of BMI on the course of the acute SARS-COV-2 infection and the post-covid period. MATERIALS AND METHODS. AKTIV and AKTIV 2 are multicenter non-interventional real-world registers. The АКТИВ registry (n=6396) includes non-overlapping outpatient and inpatient arms with 6 visits in each. The АКТИВ 2 registry (n=2968) collected the data of hospitalized patients and included 3 visits. All subjects were divided into 3 groups: not overweight (n=2139), overweight (n=2931) and obese (n=2666). RESULTS. A higher BMI was significantly associated with a more severe course of the infection in the form of acute kidney injury (p=0.018), cytokine storm (p<0.001), serum C-reactive protein over 100 mg/l (p<0.001), and the need for targeted therapy (p<0.001) in the hospitalized patients. Obesity increased the odds of myocarditis by 1,84 times (95% confidence interval [CI]: 1,13–3,00) and the need for anticytokine therapy by 1,7 times (95% CI: 1,30–2,30).The patients with the 1st and 2nd degree obesity, undergoing the inpatient treatment, tended to have a higher probability of a mortality rate. While in case of morbid obesity patients this tendency is the most significant (odds ratio — 1,78; 95% CI: 1,13-2,70). At the same time, the patients whose chronical diseases first appeared after the convalescence period, and those who had certain complaints missing before SARS-CoV-2 infection, more often had BMI of more than 30 kg/m2 (p<0,001).Additionally, the odds of death increased by 2,23 times (95% CI: 1,05-4,72) within 3 months after recovery in obese people over the age of 60 years CONCLUSION. Overweight and/or obesity is a significant risk factor for severe course of the new coronavirus infection and the associated cardiovascular and kidney damage Overweight people and patients with the 1st and 2nd degree obesity tend to have a high risk of death of SARS-CoV-2 infection in both acute and post-covid periods. On top of that, in case of morbid obesity patients this tendency is statistically significant. Normalization of body weight is a strategic objective of modern medicine and can contribute to prevention of respiratory conditions, severe course and complications of the new coronavirus infection.

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.

На сегодняшний день особое внимание уделяется вопросам коморбидности особенно часто встречающихся нозологий ввиду активного внедрения в клиническую практику принципов индивидуального подхода к лечению каждого пациента. Настоящая статья посвящена клиническому фенотипу «головная боль напряжения и артериальная гипертония». Большое значение имеет его своевременная диагностика, так как вовремя поставленный правильный диагноз позволит увеличить эффективность и безопасность лечения, улучшить качество жизни пациентов, а также уменьшить риск сердечно-сосудистых осложнений. В данной статье представлен клинический случай пациентки 56 лет, обратившейся в Отделение общей врачебной практики Красноярского государственного медицинского университета имени профессора В. Ф. Войно-Ясенецкого с жалобами на учащение приступов хронической головной боли. В анамнезе имеется длительный стаж головной боли и повышения артериального давления, отягощенный наследственный анамнез со стороны матери по головной боли напряжения и артериальной гипертонии. Длительное время занималась самолечением и имела низкую комплаентность к гипотензивной и обезболивающей терапии. В ходе проводимого обследования, включающего неврологический осмотр, использование специализированных шкал и опросников для оценки наличия когнитивно-аффективных расстройств, оценку субъективного ощущения боли с помощью цифровой аналоговой шкалы, выполнение лабораторных и инструментальных методов исследования, ночного респираторного мониторинга, а также анализ дневника головной боли, индексов времени, потерянного из-за головной боли, и влияния головной боли, шкал дневной сонливости и ответа на терапию головной боли, было выявлено два заболевания – головная боль напряжения и артериальная гипертония, протекающие самостоятельно и независимо друг от друга, но при этом существенно утяжеляющие течение друг друга (т. е. клинический фенотип).С учетом полученных результатов терапия была скорректирована, пациентка поставлена на учет к неврологу, кардиологу. Сделан вывод о важности комплексного и междисциплинарного подхода в ведении пациентов с клиническим фенотипом «головная боль напряжения и артериальная гипертония». Today special attention is paid to the issues of comorbidity of particularly common nosologies due to the active introduction into clinical practice of the principles of an individual approach to the treatment of each patient. This article is devoted to the clinical phenotype «tension-type headache and arterial hypertension». Its timely diagnosis is of great importance, as a timely correct diagnosis will increase the effectiveness and safety of treatment, improve the quality of life of patients, as well as reduce the risk of cardiovascular complications. This article presents a clinical case of a 56-year-old patient who applied to the Department of General Medical Practice of Professor V. F. Voino-Yasenetsky Krasnoyarsk State Medical University with complaints of increased frequency of attacks of chronic headache. She had a long history of headache and high blood pressure, burdened with a hereditary history on the mother's side of tension-type headache and arterial hypertension. She had been self-medicating for a long time and had low compliance with hypotensive and analgesic therapy. During the examination, which includes neurological examination, the use of specialized scales and questionnaires to assess the presence of cognitive-affective disorders, the assessment of the subjective sensation of pain using a digital analog scale, laboratory and instrumental research methods, night respiratory monitoring, as well as analysis of the headache diary, indices of time lost due to headache, and the effects of headache, daytime sleepiness scales and response to headache therapy, two diseases of tension-type headache and arterial hypertension were identified, proceeding independently and independently of each other, while significantly aggravating the course of each other (i.e. clinical phenotype). Taking into account the results obtained, the therapy was adjusted, the patient was registered with a neurologist, cardiologist. The conclusion is made about the importance of an integrated and interdisciplinary approach in the management of patients with the clinical phenotype «tension-type headache and arterial hypertension».

Repetitive quarantines and social restrictions during the coronavirus disease 2019 (COVID-19) pandemic have negatively affected the population health in general, and the control of hypertension (HTN) in particular.Aim. To evaluate the control of HTN in the Russian population during the COVID-19 period based on the results of screening for HTN May Measurement Month 2021 (MMM2021).Material and methods. During May-August 2021, 2491 participants from 11 Russian regions took part in the screening. Participation was voluntary without restrictions on sex. All participants were over 18 years of age. During the screening, blood pressure (BP) was measured three times using automatic and mechanical BP monitors. In addition, a questionnaire was filled out on behavioral risk factors, comorbidities and therapy. HTN was diagnosed with systolic BP ≥140 mmHg and/ or diastolic blood pressure ≥90 mmHg and/or taking antihypertensive therapy. The questionnaire included questions about prior COVID-19, vaccinations and their impact on the intake of antihypertensive drugs.Results. The analysis included data from 2461 respondents aged 18 to 92, of which 963 were men (39,1%). The proportion of hypertensive patients was 41,0%, while among them 59,0% took antihypertensives and 30,9% were effectively treated. In comparison with pre-pandemic period according to MMM2018-2019, the higher proportion of HTN patients in the Russian sample was revealed during MMM2021 (41,0% vs 31,3%, p<0,001) with a comparable proportion of patients receiving antihypertensive therapy (60,7% vs 59,0%, p=0,05) and treatment efficacy (28,7% vs 30,9%, p=0,36). Monotherapy was received in 44,7% of cases, while dual and triple combination therapy — in 30,9% and 14,1%, respectively. The majority of respondents (~90%) did not adjust their antihypertensive therapy during the COVID-19 pandemic.Conclusion. According to HTN screening in Russia, there is persistent ineffective control of HTN, which may be due to both the worsening pattern of behavioral risk factors, limited access to healthcare during COVID-19, and the inertia of physicians and low adherence of patients due to the asymptomatic HTN course in the majority.

Nitric oxide (NO) plays an important pathogenetic role in vascular relaxation and is a candidate molecule of a common pathogenetic link in the development of arterial hypertension (AH) and tension-type headache (TTH). Objective of the study was to study the association of the single nucleotide variant (SNV) rs2297518 of the NOS 2 gene with the risk of developing AH and clinical “AH + TTH” phenotype in adults living in a large industrial city of Eastern Siberia. Design and methods. All participants (N = 91) were divided into two groups: group 1 (patients with AH) — 60 people, including the main subgroup (patients with AH without headache) — 30 people and a comparable subgroup (patients with clinical phenotype “AH + TTH”) — 30 people; group 2 (control — healthy volunteers) — 31 people. Carriage of the SNV rs2297518 gene NOS 2 (locus 17q11.2) was determined using real-time polymerase chain reaction. Results. The minor allele A rs2297518 of the NOS 2 gene was statistically significantly associated with a high risk of developing AH (odds ratio (OR) = 8,43 [95 % confidence interval (CI): 2,33–30,46], p = 0,000223) and phenotype “AH + TTH” (OR = 5,44 [95 % CI: 1,46–20,21], p = 0,006) compared with the control group. The heterozygous genotype GA rs2297518 of the NOS 2 gene also was statistically significantly associated with a high risk of developing AH (OR = 8,17 [95 % CI: 2,03–32,79], p = 0,001). Conclusions. The study demonstrated that the minor allele A of the SNV rs2297518 (26096597 G > A) of the NOS 2 gene, which encodes the inducible NO-synthase (iNOS), can be considered as a clinically significant genetic biomarker, first of all, of AH in the Caucasian population of Eastern Siberia. At the same time, future studies may clarify the role of this SNV as a genetic biomarker of the “AH + TTH” phenotype.

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.

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).ResultsThe 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.

Primary headaches are common neurological problem in the world. Migraine (M) and tension type headache (TTH) are the leaders in the structure of primary headaches in the population; (1) Background: The study of the association of single nucleotide variants (SNVs) of MTHFR (meth-ylenetetrahydrofolate reductase) and HTR2C (5-Hydroxytryptamine Receptor 2C) genes with M and TTH development in the European population in Siberia (Russia); (2) Methods: 192 adults were examined: 82 (42.7%) males and 110 (57.3%) females. Control group: 81 healthy adults, median age 49.5 [36; 59] years; 53 (66.7%) males and 27 (33.3%) females. Headache group consisted of 111 patients with primary headache, median age 54 [45; 64] years, including two subgroups: subgroup 1 (M) of 39 patients; subgroup 2 (TTH) of 72 patients. Carriage of alleles and genotypes rs1801133 and rs1801131 of the MTHFR gene and rs6318 of the HTR2C gene was determined using PCR-RT by TaqMan allelic discrimination technology; (3) Results: A statistically significant association of the carriage of the A allele rs1801133 of the MTHFR gene with the formation of M (p = 0.025) and TTH (p = 0.022), as well as the GA genotype with the development of TTH (p = 0.024) was revealed. Carriage of the G allele and the TG and GG genotypes of the MTHFR gene, associated with a decreased activity of the MTHFR enzyme, does not affect the development of primary headache. A statistically significant association was revealed between the carriage of the heterozygous GC genotype (rs6318) of the HTR2C gene and the formation of M (p = 0.013); (4) Conclusions: Carriage of the A allele (OR 1.77; 95% CI 1.09-2.89) and the GA genotype (OR 2.24; 95% CI 1.17-4.29) rs1801133 of the MTHFR gene is a risk factor for the development of TTH (p <0.05). Carriage of the A allele rs1801133 of the MTHFR gene is a risk factor for the development of M (OR 1.97; 95% CI 1.08-3.57; p <0.05). Carriage of the variant G allele and rs1801131 GT and GG genotypes associated with reduced activity of the MTHFR enzyme does not affect the development of primary headache. In the control group, the prevalence of the T allele associated with normal enzymatic activity was noted (p = 0.024). Carriage of the heterozygous genotype CG SNV rs6318 of the HTR2C gene increases the risk of developing migraine by 3.6 times.

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.

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.

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.

Introduction. Cardiovascular comorbidity is a relevant problem in modern medicine. Comorbid pathology significantly worsens the quality of life and increases the likelihood of death in cardiovascular patients. The combination of diseases requires a comprehensive examination of the patient and the choice of optimal therapy. This work reviews the structure of cardiovascular comorbidity in outpatient patients of Krasnoyarsk, analyzes the most frequently prescribed medications, and makes conclusions about the need to highlight the problems of combined pathologies in outpatient practice.Aim. To study the structure of cardiovascular comorbidity in outpatient patients in the city of Krasnoyarsk, to assess the frequency of comorbid pathologies in cardiovascular patients, and to analyze the extent of the prescribed therapy.Material and Methods. A one-stage retrospective study analyzed 1,928 ambulatory medical charts of cardiovascular patients who visited the primary care physicians in the polyclinics of Krasnoyarsk in 2018. The material was statistically processed, and diff erences were considered statistically significant at p < 0.05.Results. The prevalence of comorbid pathologies in cardiovascular patients reached 87% and tended to rise with the patients’ age. The study showed that coronary heart disease (CHD) and obesity were associated with type 2 diabetes mellitus (T2DM) in agreement with results reported in previous studies. 43.2% of patients achieved a blood pressure level (BP) < 140/80 mm Hg while on antihypertensive therapy. 46.8% of patients achieved total cholesterol (TCh) < 5.0 mmol/L while taking statins. Only 18.5% of T2DM patients and 15.9% of patients with chronic kidney disease (CKD) who were taking statins had TCh < 4.5 mmol/L. Heart rate (HR) < 70 bpm was reached in about 40% of patients taking b-blockers.Conclusions. Comorbidity prevalence among cardiovascular patients of Krasnoyarsk city was high and tended to increase with the increase in patient age. Arterial hypertension (AH) and T2DM was the most frequent combination among patients with cardiovascular diseases (CVD). Administered antiplatelet, hypolipidemic, and antihypertensive therapies did not fully comply with the current clinical recommendations in regard to the regimen of administration, dosage, and rates of the treatment targets achieved. The study showed that cardiovascular diseases are most frequently combined with T2DM. In this regard, it is necessary to promote the population awareness of the primary and secondary prevention of these comorbid diseases.