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Heart rhythm disorders are one of the most common complications of coronavirus infection. Heart rhythm disorders can develop in 6-17% of hospitalized patients, and in convalescents, COVID-19 can manifest itself up to 12 months after the completion of the acute phase of the disease. Among the mechanisms for the development of cardiac arrhythmias, there are a direct cytopathic effect of SARS-CoV-2 on the myocardium, systemic inflammatory response syndrome, electrolyte imbalance, hypoxia, the use of antibacterial, antimalarial and antiviral drugs, exudative pericarditis, autonomic dysfunction. The main COVID-19-mediated heart rhythm disorders are sinus tachycardia and bradycardia, atrial fibrillation, ventricular tachycardia, long QT syndrome. Despite a significant amount of research, the literature data on the prevalence of certain types of cardiac arrhythmias (especially in COVID-19 convalescents), as well as methods for their correction, are somewhat contradictory and need to be clarified. Taking into account the impact of arrhythmia on the quality of life and mortality, active monitoring of convalescents of coronavirus infection, identification and development of approaches to the treatment of heart rhythm disorders in patients who have had COVID-19, seem to be relevant and promising areas in modern cardiology.

Aim: Diabetes mellitus (DM) is known to be a risk factor in adverse outcomes and complications in many infectious diseases. In the combination of hemorrhagic fever with renal syndrome (HFRS) and DM there are mutually exclusive pathogenetic States - hyperosmolarity, characteristic of DM is layered on the reduction of osmotic blood pressure in HFRS. Under these conditions, the effect of one disease (DM) on the clinical manifestations of another (HFRS) is not obvious. The aim of the work is to find out the clinical features during hfps in patients with DM., Materials and Methods: The study is based on the results of the retrospective studies "case - control" - studied the information contained in medical records of patient (form 003/u), who suffered HFRS in 2006-2018. The Selection of cards produced randomly. In the end, there were formed two groups: the first - 981 patient who suffered HFRS and had no signs of diabetes; the second, 33 patients who suffered HFRS on the background of previously existing (28 people), or the first identified (5) diabetes., Results: With a combination of HFRS and DM, a mild course of the disease is 2.5 times more common, there are no severe forms. Among this group of patients, complications are almost 10 times less common, less likely to develop infectious - toxic shock, acute kidney damage (class F by RIFLE), pulmonary edema. The combination of DM and HFRS is manifested by less high and prolonged fever, less high levels of urea and creatinine in the blood., Conclusion: HFRS in combination with DM is easier, apparently, high osmolarity of the blood is a stabilizing factor during the disease.

Aims: Assessment of global longitudinal strain of left ventricle and coronary bloodflow in patients with primary subclinical hypothyroidism., Materials and Methods: The study involved 23 women with primary subclinical hypothyroidism of age from 55 to 75 years. Physical examination, transthoracic EchoCG, coronary bloodflow assessment and global LV longitudinal strain by speckle tracking method were performed to all patients. The data obtained were compared to the results of 20 women without any thyroid diseases comparable to the main group by age and concomitant diseases., Results: Patients with primary subclinical hypothyroidism have signs of diastolic dysfunction significantly more frequently than in control group, and increased values of posterior left ventricle wall and interventricular septum thickness. Global longitudinal strain of left ventricle in patients with hypothyroidism was lower than in control group and patients with hypothyroidism had higher FVI values in perforant coronary arteries., Conclusion: Patients with subclinical hypothyroidism demonstrated decrease of global longitudinal strain and increase of volume bloddflow rate in performant coronary arteries.

Ixodes tick-borne borrelioses (ITBB) are caused by two different spirochetes: Borrelia from the group of Borrelia burgdorferi sensu lato, the agents of the classic Lyme borreliosis (LB), and Borrelia miyamotoi that belongs to the group of Borrelia causing tick-borne relapsing fevers. ITBB caused by B. miyamotoi (BM-ITBB) is a previously unknown infectious disease discovered in Russia. It is known that the LB sequelae may reduce the long-term life guality of convalescents., Aim: To study the follow-up of those who have recovered from new BM-ITBB infection in comparison with persons who have had LB., Subjects and Methods: The investigation enrolled 41 patients with BM-ITBB and 41 patients with LB who were treated at the Republican Infectious Diseases Hospital of Udmurtia. Within a year after the disease, they were followed up through clinical and instrumental examination of cardiac performance, expanded biochemical analysis of blood and urine, which could; estimate kidney and liver functions, and psychological questioning., Results: Asthenic syndrome and complaints about and objective signs of cardiac dysfunctions persisted supraventricular extrasystoles, left ventricular diastolic dysfunction, and elevated and/or unstable systolic blood pressure were detected in 20-30% of the convalescents for a long time. Kidney dysfunctions were manifested in albuminuria and the decrease of glomerular filtration rate. A year following the disease, 10-20% patients had persistently elevated concentrations of alanine aminotransferase, aspartate aminotransferase, and C-reactive protein and had higher levels of total cholesterol and low-density lipoproteins. The pathological consequences of ITBB were polymorphic and varied in different patients; in general, only 68% of them showed health improvement., Conclusion: We assume that a significant role in the pathogenesis of BM-ITBB and LB is played by vascular endothelial damage possibly associated with the inflammatory and autoimmune aspects of an immune response in Borrelia infection. The consequences of this damage may persist and even intensify during a year, which provokes chronic dysfunction of the heart, kidney, or liver in a number of convalescents.

Aim: The objective of this study was to confirm the role of B. miyamotoi in the etiology of ITBB-WOEM in Udmurtia and to investigate in detail the clinical presentation of this "new" disease., Materials and Methods: 50 adult patients with ITBB-WOEM treated in Republic Hospital for Infectious Diseases, Udmurtia, in 2010-2011 had PCR-confirmed infection by B. miyamotoi. The laboratory evidence of co-infection by other pathogens, including tick-borne encephalitis virus, B. burgdorferi sensu lato, A. phagocytophilum, E. chaffeensis, and E. muris, were absent., Results: All patients had a tick bite from 10 to 18 days before the acute disease onset. The main clinical signs were high fever, fatigue, headache, chill, and sweat. Clinical, biochemical, and instrumental investigations also showed the signs of functional impairment of various organs: the liver (in about half of the patients), kidney (in 10 patients), heart (6 patients), etc. In contrast, acute ITBB with erythema migrans was usually a localized infection without a pronounced intoxication syndrome and impairments of the organs., Conclusion: ITBB-WOEM caused by B. miyamotoi is a systemic disease that is clinically closer to relapsing fevers transmitted by argasid ticks than to Lyme borreliosis. The number of B. miyamotoi infections in Russia may be comparable with that of Lyme disease cases, so the investigations of epidemiology, clinical presentation and therapy of this "new" disease are urgently requested.

Aim: To evaluate renal function, persistence of renal dysfunction and probability of chronic renal pathology in convalescents of hemorrhagic fever with renal syndrome (HFRS)., Material and Methods: A total of 370 HFRS convalescents were examined with estimation of renal functional reserve, albuminuria, uric acid clearance, activity of urine N-acetil-beta-D-hexosaminidase in the urine, 18-h deprevation test, duplex scanning of renal vessels. Correlation between prevalence of chronic renal failure in Udmurtia and HFRS incidence was analysed., Results: Glomerular and tubular dysfunctions in HFRS convalescents (intraglomerular hypertension, albuminuria, regress of a concentration ability of the kidneys, impairment of tubular transport) are characterized by persistence in the presence of renal hypoperfusion and hypoexcretory hyperuricemia. 13% convalescents developed chronic disease of the kidneys (CDK) which clinically presented as chronic tubulointerstitial nephritis. HFRS may contribute to formation of population of patients with chronic renal failure in the territory of active natural foci. A significant positive correlation was registered between mean annual levels of HFRS morbidity and prevalence of chronic renal failure in different regions of Udmurtia. According to clinical data, chronic renal failure develops in patients who earlier have suffered from renal disease., Conclusion: Persistance of renal dysfunctions in HFRS convalescents and possible onset of chronic disease of the kidneys necessitate active follow-up of the disease convalescents.

Aim: To characterize late convalescence after hemorrhagic fever with renal syndrome (HFRS), i.e. metabolic disorders and their relation with arterial pressure (AP) and renal function., Material and Methods: 202 HFRS convalescents were followed up with measurements of AP, purin, carbohydrate and lipid metabolisms, study of glomerular and tubular dysfunctions., Results: A stable rise of arterial pressure registered in 24% HFRS convalescents was associated with intraglomerular hypertension, affected concentration ability of the kidneys and tubular transport of beta 2-microglobulin in the presence of metabolic disorders: hyperuricemia, hyperinsulinemia and hyperlipidemia of type IIa. A significant correlation was found between arterial hypertension and renal dysfunction and metabolic disorders., Conclusion: Late convalescence after HFRS is characterized by glomerular and tubular dysfunctions, persistent elevation of AP and hormonal-metabolic atherogenic and diabetogenic disturbances.

Tolerance of physical load was investigated in 50 convalescents of hemorrhagic fever with renal syndrome (HFRS) at bicycle exercise test (BET). Calculations were made of maximal oxygen consumption and energy consumption at the threshold load. It is shown that for three months after HFRS physical performance of the convalescents remained low. By the end of the expected disability objective recovery of physical performance was registered only in 33-37% convalescents. More than for 3 months disability persisted in reconvalescents engaged in professions with energy consumption above 4.1 kkal/min throughout the working day. Use of BET in the practice of medical labour expertise of HFRS convalescents provides an objective assessment of their working ability and feasible job.

A clinicofunctional analysis of the heart was made in 50 patients suffering from hemorrhagic fever with renal syndrome (HFRS) in the acute period and at the stage of outpatient rehabilitation. Comparison with healthy subjects was made by physical, ECG, echo-CG data, changes in the levels of creatinphosphokinase (MB-fraction) (CPK-MB), asparagine and alanine aminotransferase in the serum. Clinical symptoms of heart pathology, their incidence rate in different periods of the disease, dynamics of ECG deviations, state of heart chambers and left ventricular systolic function are described. The most manifest changes of the studied parameters were observed in acute disease and depended on the disease severity. The detected changes in the end part of the ventricular complex on ECG associated with a relative depression of left ventricular systolic function as well as a rise in the level of CPK-MB indicate affection of the myocardium. Variants of combination and dynamics of the above disorders allowed to single out the most probable syndromes of heart affection in HFRS.

Aim: To characterize nephropathy in patients recovering after hemorrhagic fever with renal syndrome (HFRS) using functional loading tests., Materials and Methods: In 65 HFRS convalescents we examined renal function under water deprivation, exercises and studied intraglomerular hemodynamics., Results: After 2-month follow-up renal functional reserve was absent in 34% of the convalescents indicating intraglomerular hypertension. Under water deprivation most of the patients showed persistent tubulointerstitial disorders. Submaximal muscular exercises aggravated glomerular and tubular dysfunction manifesting with microalbuminuria, increased excretory beta 2-microglobulin fraction, low concentration reserve., Conclusion: Functional loading tests provide more detailed characterization of renal function in HFRS convalescents.

160 presenile and senile CHD patients received calcium antagonists nifedipine, verapamil, diltiazem. The highest antianginal effect occurred after a course of verapamil with special effect in those functionally compromised. Rheoencephalographic picture was dependent on the initial functional class of the patient and overall treatment efficacy. The response was associated with low hydrocortisone and thyroxine levels, high glucose tolerance and content of ionized calcium.

Laboratory and functional tests were made in 50 convalescents who had suffered hemorrhagic fever with renal syndrome (HFRS). It is shown that nephropathy in such patients runs with a decline in renal functional reserve indicative of intraglomerular hypertension, impaired ability of the kidneys for osmotic urine concentration, defective tubular reabsorption of beta 2-microglobulin, microcirculatory disorders, collagen disbolism, high levels of uric acid in the blood. The occurrence of hyperuricemia and intraglomerular hypertension in HFRS convalescents calls for special consideration as leading nonimmune factors of nephropathy progression.