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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 yearsCONCLUSION.  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: Study the impact of various combinations of comorbid original diseases in patients infected with COVID-19 later on the disease progression and outcomes of the new coronavirus infection., Materials and Methods: The ACTIV registry was created on the Eurasian Association of Therapists initiative. 5,808 patients have been included in the registry: men and women with COVID-19 treated at hospital or at home., Clinicaltrials: gov ID NCT04492384., Results: Most patients with COVID-19 have original comorbid diseases (oCDs). Polymorbidity assessed by way of simple counting of oCDs is an independent factor in negative outcomes of COVID-19. Search for most frequent combinations of 2, 3 and 4 oCDs has revealed absolute domination of cardiovascular diseases (all possible variants). The most unfavorable combination of 2 oCDs includes atrial hypertension (AH) and chronic heart failure (CHF). The most unfavorable combination of 3 oCDs includes AH, coronary heart disease (CHD) and CHF; the worst combination of 4 oCDs includes AH, CHD, CHF and diabetes mellitus. Such combinations increased the risk of lethal outcomes 3.963, 4.082 and 4.215 times respectively., Conclusion: Polymorbidity determined by way of simple counting of diseases may be estimated as a factor in the lethal outcome risk in the acute phase of COVID-19 in real practice. Most frequent combinations of 2, 3 and 4 diseases in patients with COVID-19 primarily include cardiovascular diseases (AH, CHD and CHF), diabetes mellitus and obesity. Combinations of such diseases increase the COVID-19 lethal outcome risk.

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).Results The 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.

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The article presents an overview of the data related to Demons-Meigs syndrome and the clinical situation associated with a complex differential diagnosis between myocarditis with the formation of secondary cardiomyopathy and Demons-Meigs syndrome. A variety of clinical symptom complexes that are associated with Demons-Meigs syndrome is discussed. The concepts of classical and non-classical, full and incomplete Demons-Meigs syndrome are considered. The current views on the pathogenesis of the syndrome and the mechanism of the formation of ascites and pleural effusion are given.

Aim: To define the safety, informative value, and performance conditions of exercise echocardiography (EchoCG) in patients with stable angina (SA) concurrent with chronic obstructive pulmonary disease (COPD)., Subjects and Methods: Forty patients aged 45 to 66 years (mean age 54.8 +/- 4.9 years) with Functional Class (FC) II-III SA concurrent with COPD and 40 patients aged 46 to 65 years (mean 56.6 +/- 4.9 years) with FC II-III SA without COPD were examined. All the patients underwent exercise EchoCG during the chosen therapy., Results: Exercise EchoCG is safe in patients with SA with COPD. To enhance the informative value of this test and to achieve the ischemic threshold in patients of this category require the use of adequate bronchodilator therapy. In this case, the informative value of the technique is 75%., Conclusion: Exercise EchoCG in patients with SA concurrent with COPD may serve as a reliable tool in determining exercise endurance during antianginal, bronchodilator therapy and in assessing its adequacy.

The aim of this work was to evaluate functional incompetence of endothelium in patients with chronic coronary heart disease (CHD, stable angina) combined with chronic obstructive pulmonary disease and to choose the most informative method for the diagnosis of endothelial dysfunction. A total of 103 patients aged 36-66 (mean 57.2 +/- 7.6) years were examined. Group 1 comprised 38 patients with CHD and concomitant chronic obstructive pulmonary disease (COPD). Group 2 included 36 patients with stable angina alone, group 3 consisted of 29 patients with COPD without CHD. Attention is focused on the characteristic of endothelial function by instrumental and laboratory methods. Comparative analysis of the severity of endothelial dysfunction in patients of the three groups revealed different mechanisms of plasma nitrogen oxide dynamics in patients with CHD and/or COPD. CHD and COPD caused mutual aggravation (potentiation) of pathological reactions leading to the development of the disease. Blood levels of nitrogen oxide metabolites in patients with cardiovascular problems or with COPD alone did not reflect the actual amount of "vasodilatory" NO. Reactive hyperemia test is believed to be the most informative method for the assessment of endothelial function in patients with CHD and COPD.

Aim: To study effects of a cardioselective beta-adrenoblocker bisoprolol on vascular wall endothelium and external respiration function in stable angina of effort combined with chronic obstructive pulmonary disease (COPD)., Material and Methods: Endothelial function and external respiration were studied before and after 4-week treatment with bisoprolol in 36 patients with stable angina and COPD using assessment of endothelium-dependent vasodilatation (EDVD) and concentrations of nitric oxide metabolites., Results: Significant improvement of endothelial function was achieved due to bisoprolol 4-week treatment which did not affect external respiration function., Conclusion: Bisoprolol is effective and safe drug in the treatment of stable angina combined with COPD. It can noticeably improve endothelial function.