While people living in that region continued identifying as Rus’ for centuries following the kingdom’s demise, several occupying forces laid claim to the land too, including the Polish-Lithuanian Commonwealth, and the Ottoman and Austrian Empires. This period of conflict led to the rise of a Cossack vassal state around Kiev, allowing Muscovy the buffer from invading forces to develop into what would become the Russian Empire.
In the United States Sildenafil used for PAH is called Revatio, to avoid being confused with Viagra. Alina also knows that even with Viagra (Revatio) her heart and lungs should have already failed. She has structural heart defects in addition to PAH. Such patients usually do not live long without transplants. Somehow Alina is still alive.