[The survival prediction of hospitalized patients with COVID-19: the role of chitotriosidase level in peripheral blood].

AIM: To assess the relationship between plasma chitotiosidase (CHIT) level and mortality in hospitalized patients with COVID-19. MATERIALS AND METHODS: 347 hospitalized patients with COVID-19 were enrolled in our single-center cohort prospective observational study. On the first day of hospitalization the patients were assessed by the level of CHIT in the venosus blood to addition to default laboratory examinations. The primary endpoint was all-cause death. The survival after hospital discharge were assessed via phone calls on 90 and 180 days since inclusion to the study (NCT04752085). RESULTS: Our study included 347 patients. The first symptoms appeared in 7 days [5; 7] before hospitalization; 283 (84.3%) patients had less than 50% of the involvement of the lung tissue to the inflammation process (CT 0-2); 36 (10.4%) patients had died since the start of our investigation; 30 (83.3%) of them died during hospitalization, others -no later than 60 days; 68 (19%) people didn't answer during phone call. The survivor's activity of the enzyme in the deceased was significantly lower in compare to deceased patients (90.5 [40.2; 178.0] nmol/h/mL vs 180.0 [77.2; 393.2] nmol/h/mL; p=0.001). Survivor of the patients with a higher level of the activity of the CHIT (more than 171 nmol/h/mL) was statically significantly lower. CONCLUSION: Rising of the CHIT's activity more than 171 nmol/h/mL might be an early independent predictor of the bad prognosis of the patients, who were hospitalized with COVID-19 infection.

[Forensic medical diagnostics of age by the Cameriere method]. / Sudebno-meditsinskaya diagnostika vozrasta po metodu Cameriere.

THE AIM OF THE STUDY: Was to conduct the comparative analysis of the age groups' separation accuracy (<18 years old; ≥18 years old) by orthopantomogram depending on the examination's side in Russian population sample. The number of orthopantomograms equal 600 (190 of male and 410 of female) aged from 14 to 23 were investigated. Index value of third molar (Im3) was calculated by the R. Cameriere method, in female and male, on the right and left sides. Index of third molar on the right and left sides shows a high correlation. In the male sample the result specificity was 0.97 on the left and 1.0 on the right, the sensitivity was 0.96 on the left and 0.94 on the right. In the female sample the values were as follows: the specificity was 0.96 on the left and 0.98 on the right, the sensitivity was 0.92 on the left and 0.94 on the right. The results showed the possibility of Im3 (0.08) use to determine the target age group for Russian citizens of both sexes regardless of examination side.

[Remote Monitoring of the QT Interval During Polychemotherapy].

Aim      To evaluate the incidence of prolonged corrected QT interval (QTc) by remote single-channel electrocardiogram (ECG) monitoring in primary oncological patients with elective polychemotherapy (PCT).Material and methods  This study included 49 oncological patients with elective PCT. A single-channel portable CardioQVARK electrocardiograph was used to record single-channel, one-lead ECG between the first and second courses of PCT.Results Analysis of QTc interval detected a prolonged QTc interval >500 msec in 8.2 % of cases, prolonged QTc >480 msec in 18.3 % f cases, and prolonged QTc interval >60 msec compared to baseline in 12.2 % of cases.Conclusion      Remote recording of single-channel ECG using a portable electrocardiograph is an effective method for recording and detecting various forms of heart rhythm disorders.

Evaluation of the effectiveness of personalised therapy for the patients with irritable bowel syndrome.

Intestinal microbiota correction in the therapy of irritable bowel syndrome (IBS) is an important medical problem. We conducted a laboratory and pilot clinical trial to investigate the effect of autoprobiotic bacteria, indigenous bifidobacteria and enterococci isolated from faeces and grown on artificial media to use as personified food additives in IBS treatment. Convincing evidence of the clinical efficacy of autoprobiotic was demonstrated by the disappearance of dyspeptic symptoms. The microbiome of patients with IBS was compared to a group of healthy volunteers and changes in the microbiome after autoprobiotic use were detected by quantitative polymerase chain reaction and 16S rRNA metagenome analysis. The possibility of reducing opportunistic microorganisms in the treatment of IBS with autoprobiotics has been convincingly proven. The quantitative content of enterococci in the intestinal microbiota was higher in IBS patients than in healthy volunteers and increased after therapy. An increase in the relative abundance of genera Coprococcus, Blautia and a decrease in the relative abundance of Paraprevotella spp. were found at the end of therapy. A metabolome study which was performed by gas chromatography and mass spectrometry demonstrated an increase in the content of oxalic acid, a decrease of dodecanoate, lauric acid, and other metabolome components after taking autoprobiotics. Some of these parameters correlated with the relative abundances of Paraprevotella spp., Enterococcus spp., and Coprococcus spp. representative of the microbiome. Apparently, they reflected the peculiarities of metabolic compensation and changes in the microbiota. Therefore, the use of autoprobiotics for treatment of IBS may lead to a stable positive clinical effect, associated with compensatory changes in the intestinal microbiota, and accompanied by corresponding changes in metabolic processes in the organism.

[Clinical and pathophysiological features of stroke in patients with COVID-19]. / Klinicheskie i patofiziologicheskie osobennosti tserebral'nogo insul'ta u patsientov s COVID-19.

OBJECTIVE: To study of modern literature on the clinical and pathophysiological features of stroke in patients with a new coronavirus infection (COVID-19). MATERIAL AND METHODS: Published data were searched in the electronic databases Medline (PubMed) and eLIBRARY for the period 2019-2022. RESULTS: It has been shown that patients with COVID-19 have a large number of risk factors for stroke, which may indicate that COVID-19 is a trigger for the development of the disease. Stroke predominantly occurs in 10-14 days after the onset of COVID-19, i.e. there was a delayed manifestation. Patients with stroke due to a COVID-19 are characterized by occlusion of large vessels or vessels, in which occlusion occurs extremely rarely, as well as the presence of several lesions. Specific laboratory signs are coagulopathy, the presence of antiphospholipid antibodies, as well as impaired liver and kidney function. This cohort of patients is characterized by high mortality and poor functional outcome (in more than 70% of cases). The pathogenetic mechanism underlying stroke has not been established yet, however, in patients with COVID-19, the activation of a cascade of blood coagulation and thrombosis reactions is recorded. Suppression of ACE2 due to the affinity of its receptors for the COVID-19 virus probably also plays a role in the pathogenesis of stroke, since when the virus enters the body, an imbalance of the renin-angiotensin system develops. CONCLUSION: COVID-19 can lead to the development of various neurological diseases, including stroke. Further researches are needed to study neuropathogenesis of COVID-19 and the impact of virus SARS-CoV-2 on disease progression.

[Epithelial protective therapy in comorbid diseases. Practical Guidelines for Physicians].

This document was produced with the support of the National Medical Association for the Study of Comorbidities (NASС). In 2021 the first multidisciplinary National Consensus on the pathophysiological and clinical aspects of Increased Epithelial Permeability Syndrome was published. The proposed guidelines are developed on the basis of this Consensus, by the same team of experts. Twenty-eight Practical Guidelines for Physicians statements were adopted by the Expert Council using the "delphic" method. Such main groups of epithelial protective drugs as proton pump inhibitors, bismuth drugs and probiotics are discussed in these Guidelines from the positions of evidence-based medicine. The clinical and pharmacological characteristics of such a universal epithelial protector as rebamipide, acting at the preepithelial, epithelial and subepithelial levels, throughout gastrointestinal tract, are presented in detail.

COVID-19-Associated Stroke.

The COVID-19 pandemic has had significant influences on the incidence of acute cerebrovascular accidents and the structure of mortality. SARS-CoV-2 increases the risks of developing both ischemic and hemorrhagic stroke. The key pathogenetic element underlying the development of cerebral stroke in COVID-19 consists of impairments to the operation of angiotensin 2 receptors, which are accompanied by accumulation of excess quantities of angiotensin 2, endothelial dysfunction, hypercoagulation, overproduction of proinflammatory cytokines, and an oxidative storm. In patients with stroke and COVID-19, lesion severity is associated with dual mechanisms of ischemia - systemic and cerebral. The possibilities of medication-based correction of both systemic impairments associated with coronavirus infection and local impairments due to ischemic or hemorrhagic brain damage, are limited. Substances with antioxidant activity may potentially be effective in patients with stroke and COVID-19. Data from a number of clinical rials indicate that Mexidol significantly improves functional outcomes in ischemic stroke. Use of Mexidol in patients with stroke and COVID-19 is advised.

Poroelastic properties of rocks with a comparison of theoretical estimates and typical experimental results.

The paper develops theoretical estimates for the parameters that describe the classical theory of poroelasticity for a fluid-saturated porous medium, with a porous elastic skeleton that can exhibit imperfect grain contacts. The results for the poroelastic properties predicted from the modelling are compared with experimental results available in the literature.

Modern Development Problems of Russian Healthcare: Part 2.

The second part of the article (see the beginning in No. 6-2021) analyzes the negative consequences of the so-called health care optimization. It is shown that as a result of its implementation, the availability of medical care has decreased. A possible way to improve the territorial organization of medical services is considered. The effectiveness of the Russian health care system in the fight against the coronavirus pandemic was assessed.

Evaluation of the Efficiency of Oxygen-Helium Therapy for Patients with Covid-19-Associated Pneumonia.

This article summarizes the experience of managing patients with COVID-19-associated pneumonia treated in one of the intensive care units of a multidisciplinary hospital with and without a heated oxygen-helium mixture. It has been shown that the use of a heated oxygen-helium mixture in the complex therapy of pneumonia caused by SARS-CoV-2 is effective. A comparative analysis of the clinical manifestations of the disease and the results of laboratory tests in the main and control groups of patients confirm with a high degree of reliability the improvement of blood oxygenation, the normalization of the acid-base balance and the positive dynamics of the main parameters, which ultimately increases the efficacy and reduces the time of treatment.

Modern Development Problems of Russian Healthcare (Part 1).

The paper (part 1) analyzes the dynamics of indicators characterizing the state of health of the Russian population. A comparative analysis of the development of healthcare in Russia and other countries is carried out. The conclusion is confirmed that the main problem in the development of Russian healthcare is the insufficient volume of public funding. The drawbacks and limited potential of the adopted funding model are assessed. A possible way to increase public funding is proposed. It is shown that the availability of medical care is reduced as a result of the so-called optimization of healthcare. A possible way to improve the territorial organization of medical services is considered. The effectiveness of the Russian healthcare system in the fight against the coronavirus pandemic is assessed.

Results of Register in Patients with Acute Coronary Syndrome and Atrial Fibrillation Receiving Rivaroxaban.

Aim      To evaluate outcomes in patients with acute coronary syndrome and atrial fibrillation who receive rivaroxaban and the patients' compliance with the antithrombotic therapy.Material and methods  The study was performed from October 2017 through December 2019 and included 129 patients. Events between the discharge from the hospital and 12 months of follow-up were recorded. The primary endpoint was development of major, minor or requiring medical attention bleeding according to the TIMI scale. The secondary endpoint was a combination of recurrent myocardial infarction, nonfatal acute ischemic cerebrovascular disease, nonfatal systemic embolism, stent thrombosis, and cardiovascular mortality.Results 32 (24.8%) patients early terminated the antiplatelet treatment and 22 (17.1%) patients terminated the rivaroxaban treatment. 26 (20.2 %) patients had hemorrhagic complications. The highest incidence of hemorrhage was observed within the first 2 months after the discharge. None of the bleedings was fatal. Composite endpoint events were observed in 24 (18.6 %) patients, including 14 (10.9 %) who died from cardiovascular causes.Conclusion      The compliance with the antiplatelet therapy was insufficient. The incidence of hemorrhagic complications was relatively high; minor and requiring medical attention hemorrhages mostly contributed to the structure of these complications. The observed incidence of recurrent ischemic events associated with a high mortality presents a more serious problem compared to hemorrhagic complications of the combination antiplatelet therapy and warrants a more aggressive tactics of the antiplatelet treatment in high-risk patients.

Clinical Characteristics and Factors Associated with Poor Outcomes in Hospitalized Patients with Novel Coronavirus Infection COVID-19.

Aim      To evaluate the clinical picture and factors associated with unfavorable outcomes in admitted patients with COVID-19.Material and methods This study included all patients admitted to the COVID Center of the National Research Center of Cardiology of the Russian Ministry of Health Care from May 1 through May 31, 2020. Clinical demographic, laboratory, and instrumental indexes and associated factors were studied with one-way and multivariate logistic regression analysis.Results This study included 402 patients aged 18 to 95 years (mean age, 62.9±14.6 years); 43.0 % of them were older than 65 years. COVID-19 was frequently associated with chronic comorbidities, including arterial hypertension (74.4 %), obesity (41.6 %), history of ischemic heart disease (12.9 %), atrial fibrillation (18.9 %), type 2 diabetes mellitus (DM) (13.0 %), and oncological diseases (9.2 %). 13.0 % of patients were smokers; less than 10% had chronic lung diseases. 3.9% of patients had a combination of COVID-19 and acute coronary pathology, including acute myocardial infarction (MI) in 3.2 % (13) and unstable angina in 0.7 % (3). The most frequent clinical manifestation of COVID-19 were four symptoms: cough (81.1 %), weakness (80.3 %), shortness of breath (71.6 %), and fever (62.7 %). 46.5% of patients had shortage of breath and chest pain/compression, 40.3% had headache, 31.1% had myalgia, 28.8% had anosmia, and 25.5% had ageusia. Arterial oxygen saturation was <93.0 % in 55.7 % of cases. According to laboratory blood tests the patients had anemia (58.2 %), lymphopenia (34.8 %), neutropenia (19.2 %), thrombocytopenia (11.9 %), and increased levels of high-sensitivity C-reactive protein (hsCRP, 87.3 %), interleukin-6 (89.3 %), ferritin (62.1 %), and D-dimer (49.2 %). 56.2% of patients required various regimens of oxygen support. 83 (20.6%) patients were admitted to intensive care and resuscitation units; invasive artificial ventilation was performed only for 34 (8.5 %) patients. In-hospital mortality was 7.7 % (31 / 402). One-way regression analysis identified major factors associated with death during the stay in the hospital: age >55 years, NEWS scale score >4.0, oxygen saturation <92.0 %, blood glucose >5.4 mmol/l, hs-CRP >25.7 mg/l, and creatinine clearance <72.0 ml/min. Furthermore, the risk increased with increasing degree of changes in each factor. According to results of the multivariate regression analysis, three most significant predictors of the hard endpoint, all-cause death during the stay in the hospital, were more than 5-fold increases in aspartate aminotransferase and/or alanine aminotransferase compared to normal levels (relative risk (RR) 16.8 at 95 % confidence interval (CI) 5.0-56.3, р<0.001), pronounced changes in the lungs consistent with a CT-4 picture as shown by computed tomography (CT) (RR 13.4; 95 % CI 3.9-45.5, р<0.001), and MI/unstable angina during the stay in the hospital (RR 11.3; 95 % CI 1.4-90.6, р=0.023). The probability of death was also considerably increased by chronic obstructive pulmonary disease, impaired kidney function (creatinine clearance estimated by Cockcroft-Gault <60.0 ml/min), type 2 DM, oncological diseases, and dementia.Conclusion      This study established factors associated with unfavorable outcomes in admitted patients with COVID-19. This will allow identifying in advance patients with a high risk of complications that require increased attention to take more active diagnostic and therapeutic measures at prehospital and hospital stages.

[COVID-19 related stroke]. / Insul't, assotsiirovannyi s COVID-19.

The COVID-19 pandemic had a significant impact on both the incidence of acute cerebral circulatory disorders and the structure of mortality. SARS-CoV-2 increases the risk of both ischemic and hemorrhagic stroke. The key pathogenetic links underlying the development of cerebral stroke in COVID-19 are impaired functioning of angiotensin 2 receptors, accompanied by the accumulation of excess angiotensin 2, endothelial dysfunction, hypercoagulation, hyperproduction of proinflammatory cytokines and oxidative storm. In patients with stroke and COVID-19, the severity of the lesion is associated with a dual mechanism of ischemia - systemic and cerebral. The possibilities of medical correction of systemic disorders associated with coronavirus infection, as well as local ones caused by ischemic or hemorrhagic brain damage, are limited. Substances with antioxidant activity could potentially be effective in patients with stroke and COVID-1.

The influence of the pore shape on the bulk modulus and the Biot coefficient of fluid-saturated porous rocks.

Fluid-saturated rocks are multi-phasic materials and the mechanics of partitioning the externally applied stresses between the porous skeleton of the rock and the interstitial fluids has to take into consideration the mechanical behaviour of the phases. In these studies the porosity of the multi-phasic material is important for estimating the multi-phasic properties and most studies treat the porosity as a scalar measure without addressing the influence of pore shape and pore geometry. This paper shows that both the overall bulk modulus of a porous medium and the Biot coefficient depend on the shape of the pores. Pores with shapes resembling either thin oblate spheroids or spheres are considered. The Mori-Tanaka and the self-consistent methods are used to estimate the overall properties and the results are compared with experimental data. The pore density and the aspect ratio of the spheroidal pores influence the porosity of the geomaterials. For partially saturated rocks, the equivalent bulk modulus of the fluid-gas mixture occupying the pore space can also be obtained. The paper also examines the influence of the pore shape in estimating the Biot coefficient that controls the stress partitioning in fluid-saturated poroelastic materials.

[Safety performance of rivaroxaban versus warfarin in patients with atrial fibrillation and advanced chro-nic kidney disease].

Aim To evaluate safety of using rivaroxaban in patients with stage 4 chronic kidney disease (CKD) or transient, stable decline of glomerular filtration rate (GFR) to 15-29 ml /min / 1.73 m2 in the presence of atrial fibrillation (AF).Material and methods This multicenter prospective, randomized study included patients admitted to cardiology departments from 2017 through 2019. Of 10 224 admitted patients 109 (3 %) patients with AF and stage 4 CKD or a stable decline of GFR to 15-29 ml /min / 1.73 m2 were randomized at 2:1 ratio to the rivaroxaban 15 mg /day (n=73) treatment group or to the warfarin treatment group (n=36). The primary endpoint was development of BARC and ISTH major, minor, and clinically relevant minor bleeding. Mean follow-up duration was 18 months.Results Patients receiving warfarin had a significantly higher incidence of BARC (n=26 (72.2 %) vs. n=31 (42.4 %), р<0.01) and ISTH (n=22 (61.1 %) vs. n=27 (36.9 %), p<0.01) minor bleeding and all ISTH clinically relevant (minor clinically relevant and major bleedings) n=10 (27.7 %) vs. n=8 (10.9 %), р=0.03]. The number of repeated hospitalizations was 65 (43% of patients) in the rivaroxaban treatment group and 27 (48% of patients) in the warfarin treatment group (р=0.57), including 24 (36.9 %) and 11 (40.7 %) emergency admissions in the rivaroxaban and warfarin treatment groups, respectively (р=0.96). Significant improvement of changes in creatinine clearance and GFR (by CKD-EPI and Cockroft-Gault) was observed in the rivaroxaban treatment group.Conclusion The study provided evidence for a more beneficial safety profile of rivaroxaban compared to warfarin in patients with AF and advanced CKD.

[Circulating Neuregulin-1 and Chronic Heart Failure with Preserved Ejection].

Chronic heart failure (CHF) with preserved ejection fraction (CHFpEF) is an unsolved, socially relevant challenge since it is associated with a high level of morbidity and mortality. Early markers for this pathology are unavailable, and therapeutic approaches are undeveloped. This necessitates extensive studying the mechanisms of CHFpEF to identify therapeutic targets. According to current notions, systemic inflammation and endothelial dysfunction play an important role in the pathogenesis of CHFpEF. These processes induce the development of myocardial fibrosis and impairment of cardiomyocyte relaxation, thereby resulting in diastolic dysfunction and increased left ventricular (LV) filling pressure. Neuregulin-1 (NRG-1) is a paracrine growth factor and a natural agonist of ErbB receptor family synthesized in the endothelium of coronary microvessels. The NRG-1 / ErbB4 system of the heart is activated at early stages of CHFpEF to enhance the cardiomyocyte resistance to oxidative stress. Preclinical and clinical (phases II and III) studies have shown that the recombinant NRG-1 therapy results in improvement of myocardial contractility and in LV reverse remodeling. Results of recent studies suggest possible anti-inflammatory and antifibrotic effects of NRG-1, which warrants studying the activity of this system in patients with CHFpEF.

[The efficacy of secondary prevention programs with remote support in coronary heart disease patients with abdominal obesity].

Background Long-term secondary preventive programs in coronary heart disease (CHD) are of highest efficacy but numerous logistical problems often compromise their implementation. Contemporary remote technologies have a potential to overcome these barriers. AIM: To assess  the impact of 2 preventive counselling programs with subsequent remote support in CHD patients with concomitant obesity. METHODS: A prospective randomized parallel-group study in 120 stable CHD patients hospitalized for elective coronary revascularization who were from 40 to 65 years old and had concomitant obesity. Patients were randomized (1:1:1) into 3 groups (n=40 each). Before discharge, Groups 1 and 2 received a single-session comprehensive counselling with focus on diet followed by remote counselling by phone (Group 1) or via text messages (Group 2). Remote counselling was delivered weekly (Months 1-3) and then monthly (Months 4-6). Group 3 received only standard advice from their attending physicians. The patients were followed for 12 months with assessment of adiposity measures, self-reported dietary patterns, physical activity (IPAQ questionnaire), smoking status, blood pressure (BP), fasting blood glucose, lipids and C-reactive protein (CRP) levels, as well as of clinical events. RESULTS: At 1 year of follow-up, the patients from both intervention groups showed a marked improvement of several risk factors including obesity: the body mass index was reduced by 1.48±0.13 kg/m² in Group 1 and by 1.53±0.18 kg/m² in Group 2; the waist circumference went down by 7.62±0.49 and by 7.41±0.74 cm, respectively; the height-normalized fat mass decreased by 4.66±0.40 kg and 5.98±0.63 kg, respectively (all P values are <0.01 vs corresponding changes in the control group). These changes were coupled with more healthy dietary patterns and less sedentary lifestyles in both intervention groups: the proportion of patients with low activity level fell from 87.5% to 2.5% in Group 1 and from 80% to 10% in Group 2 (both p values <0.01 vs control). In Group 1, BP decreased by 18.08±2.20 mmHg (systolic) and 8.56±1.61 mmHg (diastolic); both р values <0.01 vs Group 3. In Group 2 systolic BP dropped by only 11.95±2.50 mmHg (non-significant) and diastolic BP by 6.33±1.52 mmHg (р<0.05 vs control). The proportion of smokers went down from 30% to 5% in Group 1 and from 22.5% to 0% in Group 2 (both p values <0.01 vs control). The fasting glucose levels decreased by 0.21±0.20 mmol/L in Group 1 and by 0.48±0.25 mmol/L in Group 2 (<0.01 vs control, both), but there were no meaningful improvements in blood lipids or CRP. CONCLUSION: Long-term (6 months) secondary prevention programs incorporating remote support technologies result into sustained improvement of key secondary prevention indicators in obese CHD patients, irrespective of the support modality (by phone or via electronic messaging).

[The Impact of Secondary Prevention Programs Incorporating Remote Technologies on Psychological Well-Being and Quality of Life in Coronary Heart Disease Patients with Abdominal Obesity].

BACKGROUND: Quality of life, which is determined both by the physical symptoms and by psychosocial risk factors, is among the primary treatment goals in coronary heart disease (CHD). Therefore, it is reasonable to assess the impact of any therapeutic interventions in CHD on these measures. AIM: To assess the changes of psychological status and quality of life in patients with CHD and abdominal obesity (AO) over time during 2 secondary prevention programs using two different modalities of remote support. METHODS: An open-label randomized study with 3 parallel groups enrolling hospitalized patients with stable CHD and AO (most hospitalizations were due to elective revascularization procedures). The patients were randomized into 2 intervention groups (Group I and Group II) and into Group III (control). Both intervention groups received secondary prevention programs including one in-hospital preventive counselling session with focus on healthy eating habits and subsequent remote support for 6 months (Month 1 to 3: once a week; Month 4 to 6: once a month). Group I received this subsequent counselling via phone calls and Group II received text messages via different platforms according to patient preferences. Group III received standard advice at discharge only. During 1 year of follow-up motivation for lifestyle changes and continued participation in secondary prevention programs, anxiety and depression symptoms (HADS), stress levels (10-point VAS) and quality of life (HeartQol) were assessed. RESULTS: A total of 120 patients were enrolled (mean age±SD, 57.75±6.25 years; men, 83.4%) who had a high baseline motivation to participate in preventive programs. At 1 year of follow-up there was a substantial improvement in anxiety and depression symptoms in Groups I and II which was absent in Group III. As a result, the proportion of patients with HADS-A score ≥8 dropped from 45.0% to 10.0% in Group I and from 40.0% to 7.5% in Group II (both р values <0.01 vs control), and the proportion of participants with HADS-D ≥8 decreased from 30.0% to 10.0% (р<0.01 vs control) and from  12.5% to 0% (р<0.05 vs control), respectively. Stress level decreased in Groups I and II by 3.95±0.38 and 3.56±0.39 баллов, respectively (both р values <0.01 vs control). The HeartQol global score increased by 1.07±0.08 points in Group I and by 0.98±0.13 points in Group (both р values <0.01 vs control). CONCLUSION: Both secondary prevention programs with long-term remote support targeting obese CHD patients resulted in improvement of pivotal measures of their psychological status i.e. into a decline of anxiety and depression symptomatology, stress reduction and into a better quality of life.

Combined immunization with attenuated live influenza vaccine and chimeric pneumococcal recombinant protein improves the outcome of virus-bacterial infection in mice.

Influenza and its bacterial complications are a leading cause of morbidity and mortality worldwide. The effect of combined immunization with live influenza vaccine and recombinant chimeric pneumococcal protein in dual infection caused by influenza H1N1 and S. pneumoniae (serotype 3) has been studied. The combined vaccine consisted of the strain A/California/2009/38 (H1N1) pdm and chimeric recombinant protein PSPF composed of immunodominant fragments of the surface virulence factors of S. pneumoniae-PsaA, PspA, and Shr1875-associated with modified salmonella flagellin. Vaccinated mice were infected with the influenza virus 24 hours before or 24 hours after the onset of pneumococcal infection. The protective effect of combined vaccination was shown on both models of viral-bacterial infection.