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.

COVID-19 is a severe infection with high mortality. The concept of the disease has been shaped to a greater extent on the basis of large registers from the USA, Spain, Italy, and China. However, there is no information on the disease characteristics in Caucasian patients.Therefore, we created an international register with the estimated capacity of 5,000 patients — Dynamics Analysis of Comorbidities in SARS-CoV-2 Survivors (AKTIV SARS-CoV-2), which brought together professionals from the Russian Federation, Republic of Armenia, Republic of Kazakhstan, and Kyrgyz Republic. The article presents the first analysis of the register involving 1,003 patients. It was shown that the most significant difference of the Caucasian population was the higher effect of multimorbidity on the mortality risk vs other registers. More pronounced effect on mortality of such diseases as diabetes, obesity, hypertension, chronic kidney disease, and age over 60 years was also revealed.

This study aimed to determine the factors that affect the development of chronic pain in patients who recovered from a critical illness and to explore characteristics of pain. Material and methods. This study included a total of 112 patients with surgical pathology who stayed in the intensive care unit (ICU) and subsequently discharged from the hospital. Before discharge, patients were assessed using a short pain questionnaire, the PainDetect questionnaire to assess the neuropathic component of pain, and the HADS questionnaire to verify the presence of anxiety and depression. After 6 and 12 months, catanamnestic data were analyzed, and neuro-orthopedic examination and repeat testing were performed. The duration of ventilation and ICU and hospital stays were assessed as risk factors. The APACHE-II scale score and the maximum SOFA scale score were used as severity parameters of critical conditions. The maximum level of C-reactive protein (CRP) was recorded as a marker of inflammation. The Charlson comorbidity index was used to assess baseline comorbidity. Results. After 6 months, pain syndrome developed in 55.6% of the patients, and after 12 months, the average pain intensity was 4 points on the verbal rating scale in 59% of the patients. Neuropathic pain was diagnosed in 34% of the patients. The most frequent location of pain was the shoulder joint area, and both shoulders were affected by pain in 58.2% of the patients. In the period from 6 months to 1 year after discharge from the ICU, the risk factors for chronic pain were the duration of ventilator use, ICU stay, and CRP level. Age and gender did not affect the development of chronic pain in patients who recovered from critical illness. Conclusions. Chronic pain is a complication in more than half of the patients with critical illness. A third of patients with chronic pain experienced neuropathic pain, which requires a comprehensive approach to relieve pain.

Objective: to analyze the association of the polymorphic marker rs4537545 (C>T) in the IL6R gene with the development of rheumatoid arthritis (RA) in the population of the Republic of Karelia. Subjects and methods. The investigation included 190 samples of DNA extracted from the whole blood of healthy individuals and 158 samples from patients with RA. Genotyping was performed using a polymerase chain reaction (PCR)-restriction fragment length polymorphism analysis. The expression level of IL6 and IL6R genes in peripheral blood leukocytes (PBLs) from healthy individuals was assessed by real-time PCR. The plasma content of interleukin-6 (IL-6) in healthy donors was measured by enzyme-linked immunosorbent assay (ELISA). Results and discussion. An association of the polymorphic marker rs4537545 (C>T) in the IL6R gene with the development of rheumatoid arthritis was found in the population of the Republic of Karelia. The risk of RA in the persons carrying the T-allele of rs4537545 in the genotypes was 2.1 times higher than that in the C-allele carriers (odds ratio (OR), 2.103; 95% confidence interval, 1.032-4.287). The genotypes were ascertained to have an effect on the level of IL6R gene in PBL and on the plasma content of IL-6 in the healthy donors. Conclusion. The polymorphic marker rs4537545 (C>T) in the IL6R gene is involved in the genetic predisposition of humans to RA development through modulation of the level of transcriptional activity of the IL6R gene and the content of IL-6.

Остеопороз (ОП)-системное заболевание скелета, для которого характерны снижение массы кости в единице объема и нарушение микроархитектоники костной ткани, приводящие к повышенной хрупкости костей и высокому риску переломов. Изменения качества костной ткани при ОП развиваются вследствие дисбаланса процессов костной резорбции и костеобразования. Результаты проспективных эпидемиологических исследований свидетельствуют о широкой распространенности ОП в популяции и его негативном влиянии на состояние здоровья населения, а также значительном экономическом ущербе [1-3]. ОП встречается у людей во всем мире независимо от расы и национальности. Эпидемиологические исследования в России показали, что ОП имеется у 30,5-33,1% женщин 50 лет и старше и у 22,8-24,1% мужчин того же возраста, следовательно, 1 из 3 женщин и 1 из 5 мужчин этой возрастной группы страдают ОП [4-6]. Клиническое значение ОП для популяции определяется в первую очередь риском переломов костей скелета, которые могут возникать после минимальной травмы. Так, у женщин старше 50 лет риск остео-Цель исследования. Оценка частоты и выраженности остеопении и остеопороза (ОП) у больных ревматоидным артритом (РА) в сравнении с таковыми при остеоартрозе (ОА). Материал и методы. В исследование включено 150 пациенток старше 18 лет с достоверным диагнозом РА или ОА, у которых оценивали факторы риска ОП. У всех больных определяли минеральную плотность костной ткани МПКТ (относительные единицы-Т-критерий) поясничного отдела позвоночника в прямой проекции (LII-LIV) и проксимального отдела бедренной кости (головка, шейка, область Варда и большой вертел) методом дихроматической рентгеновской абсорбциометрии на денситометре LUNAR DPX-NT. Результаты исследования. У больных РА в постменопаузе отмечена большая частота остеопении и ОП, преимущественно за счет потерь МПКТ в области Варда и поясничном отделе позвоночника. У больных ОА в постменопаузе остеопения часто выявлялась на уровне как бедра, так и позвоночника, а ОП был более характерен для поясничного отдела позвоночника. По данным регрессионного анализа, среди пациенток в постменопаузе, страдающих РА, наибольший риск развития ОП в области шейки бедра и поясничном отделе позвоночника имеют женщины старше 60 лет, в области большого вертела и шейки бедра-пациентки с низким индексом массы тела, а в области шейки бедра-с высокой активностью заболевания. Заключение. При РА по сравнению с ОА выше риск развития остеопении и ОП, при этом самыми значимыми факторами риска оказались низкий индекс массы тела, пожилой возраст, высокая активность и более тяжелый функциональный класс РА.