INTRODUCTION: Common mental disorders anxiety and depression are prevalent among patients with cardiovascular disease (CVD) and diabetes mellitus type 2 (DM) and can negatively influence treatment outcomes and healthcare expenses. Despite the importance of management of depression and anxiety in primary care facilities, the diagnostics and treatment of these disorders remain insufficient in the Russian Federation. AIM: To explore whether the rates of referrals to psychiatrists and indicated pharmacological treatment received due to depression or anxiety among patients with CVD and DM will significantly change in primary healthcare facilities after the training of primary care physicians (PCPhs) to deal with comorbid depression and anxiety (including the algorithm for referral to a psychiatrist). METHODS: Patients in primary care outpatient settings with diagnoses of CVD and DM passed screening on anxiety and depression using the Hospital Anxiety and Depression Scale (HADS), and information about the indicated treatment for anxiety or depression was collected when present (Sample 1: n=400). The educational programme for PCPhs on the diagnostics of anxiety and depression was then performed, and PCPhs were instructed to refer patients with HADS 7 to a psychiatrist. After the training, the second sample was collected (Sample 2: n=178) using the same assessments as for Sample 1. The independent expert (psychiatrist) evaluated whether the patients had received the indicated pharmacological treatment according to the screening criteria used in the study for anxiety and depression for both samples. RESULTS: The proportions of patients with borderline abnormal and abnormal HADS scores (7) were 365 (91.2%) and 164 (92.1%) in Sample 1 and Sample 2, respectively. In Sample 1, among patients with HADS 7, 119 (29.8%) received psychopharmacological treatment, but in only 46 (38.7%) cases was it indicated in compliance with the screening criteria. In Sample 2, among patients with HADS 7, 59 (33.1%) received psychopharmacological treatment, and in only 14 (23.7%) cases was it indicated in compliance with the screening criteria. The differences in the indicated pharmacological treatment were not statistically significant, and no one from Sample 2 with HADS 7 met a psychiatrist through PCPh referral. CONCLUSIONS: Anxiety and depression are prevalent in patients with CVD and DM treated in primary care facilities, but these patients may not be receiving the indicated pharmacological treatment. Barriers to referral and the use of psychiatric consultation exist despite the focused training of PCPhs and the straightforward referral protocol provided.

Multidrug resistance of pulmonary pathogens in patients with cystic fibrosis (CF) requires new therapeutic solutions.The aim. To assess the effect of ceftazidime/avibactam (cef/avi) on clinical outcomes of pulmonary exacerbation of cystic fibrosis.Methods. This open single-group observational prospective non-interventional study was conducted in the routine clinical practice settings. Patients over 18 years with a confirmed diagnosis of CF and an exacerbation of a pulmonary infection were included into the study after physician’s decision to prescribe cef/avi. The examinations were performed at baseline and on Days 5 to 7, 21, and 30.Results. The analysis included data from 32 patients, 12 (38%) males and 20 (63%) females. The mean age was 31.6 years. Symptoms of exacerbation persisted in 97 % of patients on Days 5 to 7 of therapy and only in 3% at Day 21. FEV₁, FVC, SpO₂ also improved by Day 21 of the study (all – p < 0.001). By Day 21, proportion of patients with CRP above 10 mg/ml grew from 71 to 9%. The average density of sputum contamination decreased from 7.2 to 5.5 CFU/ml. Quality of life according to Cystic Fibrosis QuestionnaireRevised (CFQ-R) questionnaire also improved.Conclusion. In patients with CF, exacerbation of lung infection in most cases is caused by multidrug resistant strains of Pseudomonas aeruginosa sometimes in combination with Staphylococcus aureus. Infectious agents (P. aeruginosa) remain highly sensitive to cef/avi (up to 91%) in this population so this justifies the use of cef/avi in treatment of a CF exacerbation. cef/avi administration led to relief of the exacerbation symptoms in 97% CF patients, as well as to significant improvement in spirometry parameters, increase in the oxygenation index, decrease in CRP and density of sputum contamination, and improved the quality of life. cef/avi administration was not associated with lethal outcomes, ICU admission, or serious adverse drug reactions.

Introduction: Understanding safety issues in competitive freediving is necessary for taking preventive actions and to minimise the risk for the athletes. Methods: We analysed occurrence of loss of consciousness (LOC) and pulmonary barotrauma (PBt) in various freediving disciplines in 988 competitions over five years (from 2019 to 2023 inclusive), with 38,789 officially registered performances (starts): 26,403 in pool disciplines and 12,386 in depth disciplines. Results: Average incident rate in competitive freediving (all cases: LOCs plus PBt, 2019−2023) was 3.43% (1,329 incidents / 38,789 starts). The average incident rate of LOC and PBt within five years were 3.31% and 0.38% respectively for all disciplines. Two disciplines present higher risk for LOC: dynamic without fins (DNF) (mean risk ratio (RR) = 1.48, 95% CI, 1.13 to 1.96, P < 0.01) and constant weight without fins (CNF) (mean RR = 2.02, 95% CI, 1.39 to 2.94, P < 0.001). The RR for PBt was not higher in any discipline. The overall risk of all types of incidents (LOC plus PBt) was also higher for DNF (mean RR = 1.55, 95% CI, 1.18 to 2.04, P < 0.01) and CNF (mean RR = 2.80, 95% CI, 1.70 to 5.04, P < 0.001). Conclusions: The disciplines without fins in the pool (DNF) and at depth (CNF) appear to be the most dangerous in terms of LOC. We may recommend that organisers and safety teams should pay a special attention to no-fin disciplines as most risky for possible LOC.