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"Arterial’naya Gipertenziya" ("Arterial Hypertension")

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Vol 26, No 3 (2020)
View or download the full issue PDF (Russian)
https://doi.org/10.18705/1607-419X-2020-26-3

EDITORIAL

240-247 3681
Abstract
The new coronavirus infection (COVID-19) is a serious threat to humanity. Although its pathogenesis has not been fully studied, angiotensin-converting enzyme 2 (ACE 2) has recently been identified as a receptor for entry into the cell of the coronavirus SARS-CoV-2, thereby contributing to the spread of infection in the body. The goal of the review was to study the significance of the renin-angiotensin-aldosterone system (RAAS) in the pathogenesis of the action of the coronavirus SARS-CoV-2, the function and regulation of ACE 2, and the effects of RAAS inhibitors in cardiovascular diseases. ACE 2 promotes the transformation of angiotensin (AT) I into AT 1–7, which have a number of beneficial effects on the state of endothelium and cardiomyocytes (vasodilation, inhibition of cell growth, inhibition of cell proliferation and inhibition of cardiomyocyte hypertrophy). SARS-CoV-2 virus, in addition to interaction with ACE 2 on the surface cells in the lungs and vascular wall, leads to dysregulation of ACE 2, which in turn leads to a shift in the balance of RAAS towards activation of ACE 1 receptors, which have the opposite effects. ACE inhibitors and angiotensin receptor blockers (ARBs) play a key role in the treatment of major cardiovascular diseases such as hypertension and chronic heart failure, and today there is no evidence that ACE inhibitors or ARBs worsen severity of cardiovascular diseases. Therefore, it is not recommended to discontinue these drugs in patients with stable cardiovascular diseases and afflicted by COVID-19. The human recombinant hrACE 2 protein may be a potential therapy for CVI by blocking virus entry and eliminating the imbalance in RAAS.

LECTURE

248-262 2741
Abstract
The 2019 coronavirus pandemic (COVID-19), due to the new SARS-CoV-2 virus, represents the greatest global public health crisis and an unprecedented challenge to find effective ways to prevent and treat. In the active phase of a pandemic, early results allow these preventive measures to be implemented on a scale compatible with the pandemic. If the results are convincing, their value will be difficult to overestimate, since additional one or two outbreaks of this infection are expected. Clinical data is emerging rapidly from a large number of people afflicted with SARS-CoV-2, which should provide clinicians with accurate evidence of the effectiveness of different preventive and treatment methods. In particular, an active search is underway for cellular mechanisms that SARS-CoV-2 uses to penetrate tissues. These include information about the receptor of the angiotensin-converting enzyme receptor (ACE 2). SARS-CoV-2, a single-stranded envelope RNA virus, attaches to cells via a viral spike (S) protein that binds to the ACE 2. After binding to the receptor, the viral particle uses the receptors of the host cell and endosomes to enter the cells. Human type transmembrane serine protease 2 (TMPRSS 2) facilitates penetration into the cell via protein S. Once inside the cell, viral polyproteins are synthesized that encode the replicate transcriptase complex. The virus then synthesizes RNA through its RNA-dependent RNA polymerase. Structural proteins are synthesized leading to the completion of the assembly and release of viral particles. These stages of the virus life cycle provide potential targets for drug therapy. Current clinical and scientific data do not support discontinuation of ACE inhibitors or angiotensin receptor blockers in patients with COVID-19, and an ongoing discussion is addressed in this review.
263-269 1274
Abstract
COVID-19 pandemic changed the setup of vascular centers. The co-existence of coronaviral infection and neurological symptoms is an important issue. On the one hand, neurological manifestations can result from acute stroke in a patient afflicted with SARS-CoV-2. On the other hand, they can be caused by the direct brain viral damage. Coronavirus damage of central neural system includes encephalitis and infection-related toxic encephalopathy. The latter can present with various manifestations (from headache to conscious disorders in severe cases). Therefore, additional diagnostic approaches and new treatment protocols are required. The paper covers important issues related to healthcare delivery for patients with neurologic symptoms in COVID-19 pandemic.
270-276 2345
Abstract
Given the risk of cardiovascular complications in COVID-19, including exacerbation of pre-existing heart disease, acute myocardial injury, and drug-related cardiac arrhythmias, echocardiography (ECHO) is one of the main diagnostic methods for examining patients with suspected infection or confirmed disease. The article presents the main statements regarding transthoracic ECHO during a pandemic. The main issues related to the FOCUS ECHO are described, as it may play important diagnostic role in case of suspected myocarditis, which can be one of the manifestations of heart damage of coronavirus infection.

CLINICAL CASE

277-287 2005
Abstract
The article reviews studies that confirm the relationship of a negative prognosis with the presence of risk factors for cardiovascular complications during respiratory infections, including novel coronavirus infection COVID-19. The article presents the relevant research results that provide evidence on the myocardial damage in coronavirus infection. We present a clinical case of a patient with confirmed diagnosis of COVID-19 and severe viral myocarditis, verified by histological and immunohistochemical studies.
288-294 1413
Abstract
A new coronavirus infection (CVI) is a challenge to the medical system of the Russian Federation and requires precise flow forecasting to take the necessary measures on time. The article provides an overview of modern mathematical tools for predicting the course of CVI in the world. The created CVI forecasting project office allowed to determine the most effective analysis tools in the Russian Federation — the ARIMA, SIRD and Holt–Winters exponential smoothing models. Implementation of these models allows for prediction of short-term morbidity, mortality and survival of patients with an accuracy of 99 % both in the Russian Federation in general and in the regions. In addition, the distribution of CVI was characterized. Particularly, Moscow and Moscow region have the maximum spread of infection, and other regions are lagging behind in the dynamics of the incidence by 1–3 weeks. The obtained models allow us to predict the course of the disease in the regions successfully and take the necessary measures in a timely manner.

REVIEW

295-303 2017
Abstract
During the COVID-19 pandemic, the efforts of many researchers around the world are aimed at finding preventive and prophylactic measures as well as therapeutic agents against SARS-CoV-2. Recent studies have showed that vitamin D deficiency could be one of many factors associated with the development and severity of acute respiratory infections, and vitamin D could be used for prevention and treatment of these patients. This review summarizes data about the role of vitamin D in the pathogenesis and prevention of respiratory viral infections, including new coronavirus infection as well as mechanisms for reducing the risk of infection with vitamin D therapy. Probably, this review will be of interest for endocrinologists and other specialists.

EXPERT OPINION

304-311 1569
Abstract

Infectious epidemic of COVID-19 caused by the new coronavirus is characterized by severe course in patients with diabetes mellitus, which presents another noninfectious pandemic accelerating for last decades. Today, according to the International Diabetic Federation data, there are 463 million patients with diabetes mellitus in the world. The burden of the COVID-19 epidemic is largely explained by a frequent combination of these two pathologies. From the previous flu epidemics and already available data of the current epidemic, diabetes mellitus and obesity are considered to be the predictors of more severe course of COVID-19 and mortality. On the other hand, SARS-CoV-2 can aggravate diabetes mellitus, via direct damage of pancreatic beta cells and the liver injury, resulting in higher insulin resistance. We discuss the mechanisms underlying the relation between coronavirus infection and diabetes mellitus and consequences of their mutual influence. Also the article reviews potential strategies of personalized therapy in COVID-19. Timely control and maintenance of individualized target glycemic level is the cornerstone of successful prevention of COVID-19 complications. Disease severity defines strategy of treatment and the choice of antihyperglycemic therapy.

312-316 1870
Abstract
Recent studies indicate that COVID-19 pandemic has significant negative consequences for the public mental health. These consequences should be assessed and analyzed in the future, but it is already clear, that mass surveys with the use of standard psychological instruments are not adequate for this purpose. The authors emphasize that all stress factors associated with the pandemic (virtual threat and informational stress, deprivation, socioeconomic stress) should be taken into account and qualitatively studied and expect an increase in the prevalence of stressrelated mental disorders and physical diseases.

REVIEWS

317-326 2550
Abstract
The article presents a narrative review, clinical observations. Special attention is given to the pathogenesis, features of neurological manifestations and mental disorders, neurological complications in coronavirus infection, illustrated by clinical cases. Neurological disorders occur in approximately 36,4 % patients with COVID-19. Currently, severe viral hemorrhagic encephalitis, toxic encephalopathy, acute demyelinating lesions of the peripheral nervous system, stroke, behavioral and emotional disorders have been described. Despite numerous publications on the neurological pathology in COVID-19, pathogenesis, risk factors, and relation between neurological disorders and coronavirus infection remain unclear. There is a need for systematization of the accumulated data on the damage to the nervous system during the COVID-19 epidemic for clinical routine use, further development of the optimal treatment strategy and implementation of effective preventive measures.

PRACTICAL GUIDELINES

327-342 1926
Abstract
The article presents a literature review on physical rehabilitation (PR) in patients with the new coronavirus infection (COVID-19) of extremely severe, severe and moderate course in acute (in the intensive care unit, ICU) and subacute (immediately after transfer from the ICU) stage of the disease in a pandemic. The authors defined the aims and principles of medical rehabilitation assistance, the appropriate amount of PR exercises, and the mechanism of interaction between the rehabilitation staff and the ICU, in conditions of increased risk of infection of medical personnel. PR programs and therapeutic exercises complexes for different clinical situations (patient models) are proposed, depending on the severity of the patient’s condition, medical care conditions and the need for various respiratory support.
343-355 3516
Abstract
Pulmonary hypertension patients are extremely sensitive to intercurrent respiratory infections which can cause disease progression and bring an adverse outcome closer. The absence of specific symptoms and typical clinical manifestations of pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension makes it difficult to verify such diagnosis in time for early specific therapy prescription. This problem becomes more significant during the COVID-19 pandemic. This review presents diagnostic algorithms for differential diagnosis of pulmonary hypertension in a patient with suspected COVID-19 infection. In this term computed tomography (CT) of the chest deserves high attention. Differential diagnostic criteria for “frosted glass” type changes at CT-scan have been developed and can be used in everyday practice. Besides this, the article describes the principles of pulmonary arterial hypertension optimal therapy choice, taking into account drug interactions and complications occurring in COVID-19 patients.


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ISSN 1607-419X (Print)
ISSN 2411-8524 (Online)