Structure Of Causes Research Articles

Показатели качества жизни у мужчин, имеющих хроническую ишемическую болезнь сердца при коморбидной ассоциации с метаболическим синдромом

The leading position in the structure of causes of death from cardiovascular diseases is occupied by coronary heart disease, which is the most serious problem of modern cardiology and medicine in general. Mortality rates from coronary heart disease are now on the decline, thanks to advances in diagnosis, treatment, and risk factor management. Chronic diseases have an important and adverse effect on the quality of life, and it is well known that its improvement is the ultimate and important goal of modern medicine. Aim. The study of quality of life indicators and factors influencing its decline in men with chronic coronary heart disease, with comorbid association with metabolic syndrome. Materials and methods. 115 men with chronic ischemic heart disease were examined, of which 67 had metabolic syndrome. Metabolic syndrome was diagnosed based on the criteria of clinical recommendations of the All-Russian Scientific Society of Cardiology in 2009. The quality of life and the degree of its decline were determined using the methodology developed by A.G. Gladkov et al. (1982) adapted by T.A. Ayvazyan et al. (1989). Results. Among the surveyed men with chronic coronary heart disease and metabolic syndrome, quality of life indicators of varying degrees of decline were found in more than 70% of the surveyed. A decrease in quality of life in men with chronic coronary heart disease with metabolic syndrome was more often observed in individuals with a five-component combination of metabolic syndrome. The most frequent metabolic syndrome clusters among men with different levels of quality of life decline were three- and four-component combinations, including abdominal obesity, arterial hypertension and dyslipidemia disorders. Conclusion. It was found that in men with chronic coronary heart disease, the decrease in quality of life was largely due to the presence of the metabolic syndrome.

The analysis of age dynamics of causes of mortality of population of elderly age groups as reserve of maintaining population of older able-bodied age

The article analyzes age dynamics of initial causes of death according to records in medical death certificates of population of older age groups. Materials and methods. The records of causes of death of 34.914 persons aged 60 years and older were used as primary source of information. The initial cause of death was determined according to the ICD-10 rules. The rate of registration by reason of death was calculated as intensive value per 100 deaths in concrete age and sex group. Each cause was coded according to the ICD-10 rules (revision 2014-2016). The belonging to group was determined by first character (letter) in four-digit code that corresponded to the Class. On the basis of analysis of structure of causes of death, the group A of causes that included five Classes of ICD-10, determined 81.4% of all deaths in population aged 60 years and older. Two Classes: "Diseases of the circulatory system" (Class IX) and "Neoplasms" (Class II) determine in all studied age groups more than a half of all deaths (from 55% to 71% of males and from 59% to 67% in females) and namely they determine mortality rate in older age groups. There are no gender differences in age characteristics of registration rate in these groups (p > 0.05), however age dynamics differ. In case of diseases of circulatory system initial cause of death is increase rate of registration at increasing of age. In case of neoplasms at increasing of age decrease of registration rate as initial cause of death is established. At that, rate of decline is higher than rate of increase that determines certain decrease of structural significance of combined contribution of these two groups of causes at increasing of age. The Group B of causes, including three Classes of ICD-10 "Respiratory diseases" (Class X), "Diseases of the digestive system" (Class XI) and "Diseases of the nervous system" (Class VI), determined in overall 11.9% of all deaths in population aged 60 years and older. The age dynamics of causes of death of population of older age groups exists for certain groups of causes and it should be considered in organizing medical care of population of older age groups.

Analysis of the cause of death among the adult population in the provision of poor-quality medical services in public health institutions of the Republic of Tajikistan

Introduction. The trend of increasing cases of harm to health/life of patients in the provision of poor-quality medical services is of particular importance in the field of public health. The purpose of the study. Analysis of the cause of death among the adult population in the provision of poor-quality medical services in public health institutions of the Republic of Tajikistan. Materials and methods. The study was conducted on the basis of data on deaths among the adult population (over 18 years) of the Republic in the structure of hospital institutions of the Republic of Tajikistan 0ver period of 2019–2021 and 6 months of 2022. Results. Over period of 2019–2022 there were registered 1881, 4119, and 2567 deceased patients older 18 years, respectively, the hospital mortality rate was 0.2; 0.6, and 0.3%. The frequency of respiratory diseases during 2020 compared to the previous year (n = 70; 0.2%) due to complications of COVID-19 increased by more than 15 times (n = 1577; 3.1%), and in 2021 decreased to 2.2 times (n = 541; 1.4%). In the structure of causes of death there were dominated complications of diseases of the circulatory system (39.5%), the consequences of surgical interventions (12.7%), followed by injuries (10.7%), tumors (3.8%) and the endocrine system (3.3%). The duration of the period before hospitalization of patients who died from surgical diseases was 8.5% — up to 1 day, 68.5% — up to 5 days and 22.8% — from 5 to 15 days. Research limitation. Pathological anatomical examination of the corpses of deceased patients, which is of key importance in establishing the causes of deaths in healthcare institutions, is carried out in the republic at an extremely low number for religious reasons. Conclusion. In state healthcare institutions of the Republic, the registration of deaths due to the provision of poor-quality medical services in the period before and after hospitalization does not correspond to reality, which requires the improvement of the reporting system in accordance with international standards.

ГАЗОВОЕ ОБОРУДОВАНИЕ В БЫТУ – РИСК ОТРАВЛЕНИЯ УГАРНЫМ ГАЗОМ

Currently, the number of cases of carbon monoxide poisoning continues to remain high. The article provides examples of the occurrence of carbon monoxide and the reasons for its accumulation in the room. According to statistics, in Russia gas poisoning ranks second in the structure of causes of death from acute poisoning of chemical etiology. Over the 6 months of 2023, 19 cases of poisoning were registered, 6 of which (31.6 %) resulted in the death of the victims. In the structure of violent death (8078 cases), fatal poisoning ranks third after mechanical injuries and mechanical asphyxia and accounts for 6.3 % (513 cases). The article presented measurements and calculations from which conclusions were drawn about the immediate causes of the formation of carbon monoxide in the room. Data from technical examinations and world literature on CO poisoning were studied and analyzed. It was found that the most common reasons for the formation of carbon monoxide in the premises were insufficient air exchange in the premises, the use of mechanical ventilation systems in apartments where this was not provided, the inoperability of ventilation ducts, the shutdown of gas equipment safety systems and violations in the installation of gas equipment. This article also provides recommendations that will allow defending yourself and your loved ones from the danger of carbon monoxide poisoning. The problem of carbon monoxide is global; in order to prevent poisoning from combustion products, everyone needs to know the rules for using gas equipment and the basic principles of air exchange.

Diseases of the nervous system as the underlying cause of death

To identify the leading causes of death in the adult population from the class of diseases of the nervous system (DNS, class G) according to medical death certificates (MDC) and to discuss the problems of their assessment. The source of information was the electronic database of the Main Department of the Civil Registry Office of the Moscow Region. All cases of class G deaths were selected (total 10.739), an analysis was carried out according to underlying cause of death (UCD) codes and the immediate cause of death. In 2022, mortality from diseases included in the DNS amounted to 130.7 per 100 000 of the population over 18 years old (100.3 among men, 191.0 among women). The average age of men is 74.3±14.1, women - 83.5±9.9 years (p<0.0001) due to the younger age of death of men from «G31.2 Degeneration of the nervous system caused by alcohol» and a higher contribution of this cause to male mortality; 82.5% of deaths were for codes G90-G99 («Other disorders of the nervous system»); 15.5% were neurodegenerative diseases (G10-G32). Sixty-six percent of all UCD in both women and men accounted for «unspecified encephalopathy» (G93.4), in 2nd place (10.5%) was «cerebral cyst» (G93.0). In 45 cases, code G93.6 (cerebral edema) was mistakenly used as UCD. Differences in the structure of causes of death at home, in hospital and elsewhere are statistically significant (p<0.00001). In 58.3%, cerebral edema and herniation were indicated as the immediate cause of death (G93.6 and G93.5). Nosologically unfounded, insufficiently well-defined UCD were established in most cases of death from DNS, In 0.5% of the total number of deaths from DNS, an erroneous presentation as UCD of transient disorders of cerebral circulation or cerebral edema was noted. The results indicate the need for an analysis of the causes of death based on a comparison of medical records and MDC.

Анализ изменений структуры насильственной смерти детей и подростков в Саратовской области за период 2018–2022 гг.

Abstract. The analysis of violent child mortality is important in developing preventive measures to reduce this indicator. Aims and Tasks. The research purpose is to analyze the structure of violent death among children in the Saratov Region in 2018–2022. Materials and Methods. The research materials include the results of forensic medical examinations of the corpses of 314 children under the age of 18 who died from external causes. Results/Discussion. We establish decrease in the rate of violent death among children from 17.7 to 12.2 per 100 thousand of the population. There is a prevalence of blunt trauma (35.7 %), asphyxia (34.7 %) and poisoning (22 %) in violent death causes among children. The dynamics showed a tendency towards an increase in the proportion of blunt trauma. We note the peak of deaths from asphyxia in 2020 (45.8 %), reveal an increase in the proportion of hangings. Asphyxia is the leading cause of death in children under 1 year old, asphyxia and blunt trauma with a high percentage of falls from high altitude (40 %) – in the 1–3 year old group. In the 4–6 years old group the main types of death are blunt trauma (38.6 %) and poisoning (36.4 %). In the 7–11 years old group asphyxia is in the lead (40.4 %), followed by blunt trauma (36.5 %) with a high percentage of traffic accidents. In 12–17 years old group blunt trauma is in the first place (38.5 %), asphyxia with a predominance of hangings is in the second place. Conclusions. As we note a decrease in the violent death of children in general, we establish a tendency of increasing the proportion of blunt trauma and a change in the structure of asphyxia with a significant increase in the proportion of hangings. Differences in the structure of causes of death in different age groups were revealed.

Естественное движение населения Коми АССР в 1946–1959 годах

The paper deals with the natural movement of the population of the Komi ASSR in 1946-1959. The post-war period was the most pronounced stage of the demographic transition in the republic. The problems of statistical accounting of the population movement in the post-war years are considered. The dynamics of absolute and relative indicators of fertility, mortality, marriage and divorce are analyzed. The influence of gender, age, nationality and type of settlement on the intensity of natural population movement is estimated. The transformation of the structure of causes of mortality, including infant mortality, is considered. Territorial differences in indicators of natural population movement at the level of urban settlements and Village Soviets are revealed.

Chronic Cor Pulmonale in the Structure of Fatal Outcomes of Pulmonary Tuberculosis

The objective: to determine the significance of chronic cor pulmonale (CCP) as a cause of death in pulmonary tuberculosis patients.Subjects and Methods. Out of 194 autopsies of tuberculosis patients who died in Hospital no. 1 of Ulyanovsk Regional Clinical TB Dispensary in 2017-2020, autopsy reports of 87 patients with pathomorphological signs of chronic cor pulmonale were selected. The nature and prevalence of pathomorphological manifestations of tuberculosis and the causes of deaths were analyzed. Statistical analysis of the results was performed using the STATISTICA-10. The significance of differences in the frequency of events was determined using the χ2 criterion in a four-field 2х2 table.Results. Chronic cor pulmonale was confirmed pathomorphologically in 44.8% of deceased pulmonary tuberculosis patients. Chronic cor pulmonale was diagnosed in 67.8% of patients in their lifetime, and in 32.2%, it was diagnosed post mortem. Of 87 deceased patients with pulmonary tuberculosis complicated by chronic cor pulmonale, 28.7% had fibrous cavernous pulmonary tuberculosis, 26.4% had infiltrative form and 44.9% had disseminated form of the disease. Decompensated chronic cor pulmonale leading to death was detected in 42.5% of the deceased, and it was predominant in the structure of causes of death in fibrous cavernous tuberculosis (84%), and this pathology was also found in the patients with infiltrative (52.5%) and disseminated (10.3%) pulmonary tuberculosis.

Problems of assessment and analysis of mortality rates in the context of the rules of the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10)

Purpose of the study: to study changes in the structure of causes of death among those who died aged 18 years and older according to medical death certificates (MDC) and to discuss the problems of assessing the contribution of certain groups of diseases and conditions to the mortality of the population. Materials and methods. The source of information was the electronic database of the Main Directorate of the Civil Registry Office (USR registry office of the Moscow Region) of the MSS for those who died at the age of 18 and older for 2019, 2021 and 2022. one of the subjects of the Russian Federation. Results: All 3 years 99 % of deaths occur in 12 classes of the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10); 3 classes (diseases of the circulatory system – DCS, nervous system – DNS and neoplasms) accounted for 70 % of deaths in 2019, 58 % in 2021 and 62 % in 2022 (the share decreased due to COVID-19). The share of DCS was 40 %, 32 % and 37.7 %; neoplasms – 15.3 % 10.9 % and 13.5 %. The greatest decrease in mortality was noted in the class of mental and behavioural disorders (MBD; 8 times: 58.4 in 2019 and 7.4 per 100 thousand in 2022). The proportion of male deaths over all 3 years was higher in the classes of injury and poisoning (IP), infectious diseases (ID), diseases of the respiratory system (DRS) and digestive system diseases (DDS). The highest age of the deceased was registered according to the classes of DNS and diseases of the genitourinary system (DGS); the youngest age in ID and IP classes. For all 3 years, more than 60 % of deaths in a hospital are registered in the classes of ID and DDS, and in 2021 and 2022 from COVID-19. Deaths at home predominate in the class of DNS and ill-defined conditions (class R). For individual codes in the classes of DCS, DNS, MBD, DGS, representing non-prohibited but unspecified causes of death, significant changes (hundreds and thousands of cases) were revealed in dynamics, which is probably due to a change in approaches to coding primary cause of death and affects the structure of mortality by classes and individual reasons. Conclusions. Significant annual changes in the number of deaths from individual causes, differences in demographic characteristics by ICD classes require clarification of the criteria for using individual 4-digit codes and subsequent analysis of mortality for clinically related groups of diseases.

MiRNAs and Their Role in Venous Thromboembolic Complications.

Venous thromboembolic complications (VTCs), which include deep vein thrombosis (DVT) and pulmonary embolism (PE), have remained a pressing problem in modern clinical medicine for a long time. Despite the already wide arsenal of modern methods for diagnosing and treating this disease, VTCs rank third in the structure of causes of death among all cardiovascular diseases, behind myocardial infarction (MI) and ischemic stroke (IS). Numerous studies have confirmed the importance of understanding the molecular processes of VTCs for effective therapy and diagnosis. Significant progress has been made in VTC research in recent years, where the relative contribution of microRNAs (miRNAs) in the mechanism of thrombus formation and their consideration as therapeutic targets have been well studied. In this case, accurate, timely, and as early as possible diagnosis of VTCs is of particular importance, which will help improve both short-term and long-term prognoses of patients. This case accounts for the already well-studied circulating miRNAs as non-invasive biomarkers. This study presents currently available literature data on the role of miRNAs in VTCs, revealing their potential as therapeutic targets and diagnostic and prognostic tools for this terrible disease.

The present-day medical demographic situation in the Republic of Karelia

The analysis of basic medical and demographic indicators (primary morbidity and disability of adult population, mortality, age structure and life expectancy) and provision of medical care in the Republic of Karelia in 2011-2020 was carried out. It established consistently high level of primary morbidity of population with respiratory diseases; injuries, poisoning and other consequences of external causes; diseases of genitourinary system. Diseases of cardiovascular system and malignant neoplasms occupy leading positions in the structure of causes of disability and mortality of population during period under review. The levels of primary morbidity, disability and mortality of the Republic population are higher than at national level. The age structure of population has regressive type, there is long-term process of demographic aging, life expectancy is gradually increasing. Since 2011, the number of out-patient clinics increased up to 3 times and their capacity increased too. The degree of provision of population with medical personnel remained stable for a decade. The number of secondary medical personnel is decreasing, while both indicators are higher than the national indocators.

Evolution of neonatal mortality in the Matanza-Riachuelo River Basin between 2010 and 2019. A comparison of Argentina, the province of Buenos Aires, and the City of Buenos Aires, 2019.

Introduction. The neonatal mortality rate (NMR) is an indicator of socioeconomic, environmental, and health care conditions. The Matanza-Riachuelo River Basin (MRRB) is the most polluted in Argentina. Objective. To analyze neonatal mortality (NM) in the MRRB between 2010 and 2019 and compare it with overall data for Argentina, the province of Buenos Aires (PBA), and the City of Buenos Aires (CABA) in 2019. Population and methods. Descriptive study based on vital statistics provided by the Ministry of Health. Results. In 2019, the NMR was 6.4‰ in the MRRB, 6.2‰ in Argentina; 6‰ in PBA; and 5.1‰ in CABA. The risk of NM in the MRRB was higher than in CABA (RR: 1.32, 95% CI: 1.08-1.61). Between 2010 and 2019, the NMR decreased in the MRRB, PBA, and Argentina; but not in CABA. The risk of NM due to perinatal conditions in the MRRB was higher than in CABA (RR: 1.30, 95% CI: 1.01-1.67). The risk of death among very low birth weight (VLBW) live births (LBs) in the MRRB was higher than in CABA (RR: 1.70, 95% CI: 1.33-2.18) and lower than in Argentina (RR: 0.78, 95% CI: 0.70-0.87). Conclusion. The evolution of NMR between 2010 and 2019 was similar in the MRRB, Argentina, and PBA. In 2019, the structure of causes and the risk of NM were similar in the MRRB, PBA, and Argentina, with a higher risk due to perinatal conditions and among VLBW LBs. The NMR among VLBW LBs was lower in the MRRB than in Argentina.

Clinical and Laboratory Characteristics of Patients with COVID-19 on the Background of Cardiovascular Diseases

The research studied the clinical and laboratory characteristics of COVID-19 patients against the background of cardiovascular diseases. A high prevalence of cardiovascular diseases (CVD) was revealed among COVID-19 patients: arterial hypertension (93.4%), chronic heart failure (60.9%), cardiac arrhythmias (40.1%), coronary heart disease (21.9%). A reliable correlation was established between the timing of hospitalization from the onset of the disease and the severity of the infection, mortality was higher in persons hospitalized on the 5–7 day of the disease (59.8%). Patients with CVD are significantly more likely to develop complications, as well as higher deaths (11.53% vs. 4.30%). Pulmonary embolism (44%), acute respiratory distress syndrome (22%), acute kidney injury (20.6%) prevailed in the structure of causes of death. Gender differences in the course and outcomes of COVID-19 were found: the severity of the course and mortality rates were higher among males. According to clinical and laboratory indicators, patients with diseases of the cardiovascular system had a more severe course and a high degree of immuno-inflammatory reactions compared with the group of patients without a premorbid background. Upon admission to the hospital, patients with COVID-19 and CVD were significantly more likely to have a lesion of the pulmonary parenchyma of CT 3 and CT 4 (P&lt;0.05), whereas in the group without concomitant cardiac pathology, lung lesion corresponded to CT 1 (P&lt;0.05); CT of the lungs in dynamics showed differences in the study groups: in patients with COVID-19 and CVD, CT 3 was recorded significantly more often, and in the comparison group — CT 1 (45% vs. 10%, (P&lt;0.05)).

Characterization of Pathogenic Microflora Causing Suppurative Septic Postpartum Complications: a Retrospective Cohort Study

Background. Suppurative septic postpartum complications occupy a leading position in the structure of causes of maternal mortality. Information about the characteristics of pathogenic microflora in various forms of complications and analysis of its resistance to antibacterial drugs determine the choice of rational therapy for this pathology.Objectives — to characterize the isolated pathogenic microflora in obstetric patients with suppurative septic postpartum complications.Methods. A retrospective cohort study was conducted at the Department of Obstetrics and Gynecology No. 2 of the Omsk State Medical University and the Department of Gynecology of the Omsk Regional Clinical Hospital. The study included 123 cesarean section patients treated from January 2013 to December 2022 who were divided into three groups: Group A — uncomplicated course of postpartum endometritis, n = 55; Group B — complicated forms of postpartum endometritis, n = 48: B1 — local complications (suture failure following cesarean section; parametritis) n = 29; B2 — pelvic peritonitis, n = 19; Group C — septic complications following critical obstetric conditions, n = 20. The pathogenic microflora of uterine and abdominal cavities was examined; the extent of contamination with a pathogen and sensitivity to antibacterial drugs were determined. The isolated microorganisms were identified using a MicroTax bacteriological analyzer (Austria), Vitek2 Compact (France) and routine methods; a disk diffusion method was employed to determine the sensitivity of microorganisms to antibacterial drugs. Calculations were performed using licensed Microsoft Office Excel 2013 and Statistica 10 programs (StatSoft Inc., USA). Nonparametric nominal data were compared using Pearson’s chi-squared test with p-value determination.Results. The pathogenic microflora was dominated by S. epidermidis, E. faecalis, E. coli, and E. faecium. In 2018–2022, a statistically significant decrease was observed in the isolation rate of S. epidermidis (p = 0.016), E. faecalis (p &lt; 0.001), and E. faecium (p = 0.05). The highest resistance was exhibited by bacteria to the following antibiotics: S. epidermidis — cephalosporins (30.16%); E. faecalis — fluoroquinolones (33.33%); E. coli — cephalosporins (65.91%) and β-lactamase-resistant penicillins (40.91%); E. faecium — aminopenicillins (64.10%) and fluoroquinolones (50.0%); А. baumannii — fluoroquinolones, cephalosporins, carbapenems (100%), and aminoglycosides (84.2%). A contamination assessment revealed a high titer of isolated microorganisms in 60.53% of cases. We found a statistically significantly higher isolation rate of S. еpidermidis (p &lt; 0.001), E. faecium (p = 0.01), and A. baumannii (p = 0.02) in the setting of pelvic peritonitis as compared to uncomplicated endometritis. In the case of suppurative septic complications due to critical obstetric conditions, the isolation rate was higher for S. еpidermidis (p &lt;0.001), E. coli (p = 0.04), E. faecium (p = 0.005), A. baumannii (р&lt;0.001), and K. рneumoniae (p = 0.04).Conclusion. The antibiotic resistance of pathogenic microorganisms calls for the development of new organ system support technologies and the use of methods capable of sorbing microorganisms and their toxins in the area of inflammation.

Shaping the climate of construction work safety

The interest in the social aspects of work safety results because the human factor plays a key role in the causes of accidents at work in construction. Statistical data for Poland confirm that organisational and human causes, in particular those related to improper behaviour of employees, account for the highest share in the structure of causes of accidents at work according to the TOL classification.Human behaviour determines the current and future state of occupational safety and requires at least interest. The key factors of human error resulting in accidents include lack of knowledge about hazards in the working environment and appropriate qualifications or irregularities in the behaviour of a group of employees in relation to the adopted social standards, established rules, or inappropriate behaviour. On the one hand, human behaviour depends on the safety culture; on the other hand, it is human behaviour that shapes the climate of work safety by consolidating certain beliefs and attitudes.The measures outlined in work allow for the creation of a desirable safety climate and enable the smooth and compliant operation of the construction site, as well as the economic benefits of minimising losses due to eliminating occupational accidents and illnesses. Social benefits, in turn, can include increased awareness and motivation of construction site personnel, made possible by shaping the desired safety climate by informing and involving workers and their social representatives.The practical application of shaping the safety climate is very important, which will also impact the quality and productivity of the work and the image of the construction workers.The article attempts to systematise terms related to the concept of security climate, and tools for shaping the security climate on the example of construction.

MARKERS OF IMMUNE INFLAMMATORY REACTION IN PATIENTS WITH GENERALIZED PERIODONTITIS AND CONCOMITANT GOUT

Among the main groups of chronic somatic diseases, it is rheumatological diseases that make the biggest contribution to the aggravation of the health. In the structure of causes for primary disability, rheumatological pathology ranks the second position after cardiovascular diseases. Gout is a chronic, progressive disease associated with a purine metabolism disorder, characterized by an increase in the level of uric acid in the blood (hyperuricemia) and deposition in the tissues of the musculoskeletal system and internal organs of the sodium salt of uric acid (urates) with the development of acute arthritis and the formation of gouty nodules (tophus). Gout and periodontitis are inflammatory diseases by their genesis and characterized by an underlying inflammation, which is known as a protective response triggered by cellular damage caused by inflammatory agents and activation of non-specific resistance factors. This study aimed at investigating the markers of the immune-inflammatory reaction in patients with comorbidity of generalized periodontitis and gout. The results obtained can serve as essential elements for the development of effective treatment and prevention strategies for this type of comorbidity. A biochemical study was conducted on venous blood samples from 60 male inpatients with gout aged from 30 to 59 years, who received treatment at the rheumatology department of Lviv Regional Clinical Hospital. Two study groups were formed: the main group consisted of 30 patients with the comorbidity of generalized periodontitis and gout; the comparison group included 30 people with generalized periodontitis but without rheumatological pathology. The results were compared with data obtained from 20 healthy individuals (control group). The patients with generalized periodontitis and concomitant gout demonstrate a significant increase in the levels of the acute-phase protein C-RB and pro-inflammatory interleukin IL-1β. The elevated concentration of C-reactive protein confirms the presence of latent inflammation that can be potentially attributed to the comorbid course of gout and periodontitis, which may irritate the endothelium through microcrystals of uric acid and toxins from periodontal pocket microorganisms. Increased activity of IL-1β, which is known as an important factor in initiating the inflammatory process and the release of various inflammatory mediators, indicates the presence of persistent subclinical activation of autoinflammatory mechanisms.

Causes of death in Almaty residents before and during the COVID-19 pandemic

Introduction. It was conducted a study of the structure and dynamics of death outcomes among Almaty residents over the COVID-19 pandemic. The leading causes of death in the population during this period may change, both through infectious morbidity and losses due to concomitant chronic non-communicable diseases associated with coronavirus infection. &#x0D; Material and methods. The material for the analysis was the registered data on case of deaths among Almaty residents in Kazakhstan between 2018 and 2020. We studied the structure and trend in cases of death by gender and age of patients, depending on the date and place of death and in view of the class of diseases.&#x0D; Results. During 2020, the number of deaths of Almaty residents increased in 1.37 and 1.40 times compared to 2018 and 2019. Differences in deaths on gender and age of patients were revealed. In trend, the number of deaths recorded in the hospital has significantly increased whereas the number of deaths at home has decreased. In 2020, five major classes of diseases dominated in the structure of causes of death: 1) I00-I99, 2) G00-G99, 3) C00-D48, 4) J00-J99, and 5) U07.1 and U07.2.&#x0D; Research limitations. All cases of deaths registered in Almaty were used to analyse the subject of the study, which increases the reliability of statistical conclusions.&#x0D; Conclusion. During the COVID-19 pandemic the structure of causes of death among residents of Almaty changed when compared with previous years. There was gain in deaths, which is primarily due to coronavirus infection and diseases associated with COVID-19. It is possible underreporting of deaths from COVID-19 among residents of Almaty which related with false registration of comorbid diseases.

Diastolic heart failure: 20 years later. Сurrent issues of pathoge-nesis, diagnosis and treatment of heart failure with preserved LVEF

Relevant aspects of the pathogenesis, diagnosis, And treatment of heart failure with preserved LV EFThis review analyzes results of studies of the recent decade that focus on epidemiology, mechanisms of development, diagnostic methods, and treatments of heart failure with preserved ejection fraction (HFpEF). As expected, the prevalence of HFpEF continues to increase due to the growing contribution of comorbidities to the structure of causes for chronic heart failure (CHF), such as arterial hypertension with left ventricular hypertrophy, obesity, chronic kidney disease, as well as due to ageing of the population and decreased contributions of ischemic heart disease and myocardial infarction. Concomitant diseases are a source of low-intensity microvascular inflammation, which is currently assigned a role of a trigger mechanism eventually provoking energy deficiency, disorders of cardiomyocyte relaxation, and diffuse myocardial fibrosis. Both these processes lead to increased heart muscle rigidity and abnormally high left ventricular filling pressure (LVFP). High LVFP is associated with the development of pulmonary venous congestion and impairment of alveolar blood oxygenation, which form the clinical picture of HFpEF. Detecting high LVEF with tissue Doppler echocardiography by the E / e' value became the instrumental basis for the HFpEF diagnostics. Recognition of inflammation and fibrosis as the key pathogenetic factors marked the main vector of modern therapy for HFpEF (anti-inflammatory and antifibrotic). The best implementation of this vector became possible with the advent of drugs from the class of angiotensin receptor and neprilysin inhibitors (ARNI), sodium-glucose cotransporter type 2 (SGLT2) inhibitors, and aldosterone antagonists. However, the efficacy of such treatments is evident only with the LV EF &lt;60-65% while at higher values, the efficacy substantially decreases. This limitation may result from the heterogenous nature of the disease and requires more advanced methods for verification of HFpEF clinical phenotypes. Among such methods, transcriptomic, metabolomic, and proteomic approaches are considered. With the use of capabilities of the "machine learning" and the artificial intelligence, these approaches can become a new frontier in research to represent an important step towards personalized medicine for patients with HFpEF.

ПОПУЛЯЦИОННЫЕ РЕЗУЛЬТАТЫ ВНЕДРЕНИЯ СИСТЕМЫ МЕРОПРИЯТИЙ ПО СНИЖЕНИЮ СМЕРТНОСТИ ОТ ЦЕРЕБРОВАСКУЛЯРНЫХ БОЛЕЗНЕЙ В СТАВРОПОЛЬСКОМ КРАЕ

Significance. In order to fulfill the Presidential Decree dated May 7, 2018 No. 204, a system of social mobilization of the population and patient routing was created in the Stavropol Territory, including a rapid detection of patients with cerebrovascular diseases (CVD), their timely hospitalization in primary vascular departments, as well as care for patients with a combination of CVD and COVID-19. The purpose of the study is to assess the impact of the developed system of measures on the CVD mortality rate. Material and methods. The authors have analyzed mortality from CVD for the period from 2018 to 2022, Rosstat official statistical data on distribution of the diseased by sex, age group and cause of death. The dynamics in indicators was compared with similar data for the North Caucasian Federal District (NCFD) and the Russian Federation. Results. In the Stavropol Territory, non-standardized and standardized mortality rates decreased, while in other regions of the Russian Federation (RF) and the North Caucasus Federal District they grew. The number of years of life lost due to CVD in the Stavropol Territory decreased by 36.9% (NCFD - by 36.8%, RF - by 29.7%). The loss of labor potential due to the increased retirement age increased by 25.0% (other regions of the North Caucasus Federal District - 22.2%; RF - by 38.1%). The relative risk of death from CVD among rural residents compared with urban residents decreased from 1.06 [1.01-1.12] to 1.02 [0.97-1.08]; in other words, became equal due to the accelerated reduction in the risk of death in rural population compared to the urban one. The share of CVD in the structure of all causes of death decreased from 17.6% to 12.4%. In the structure of causes of death from CVD, there was a decrease in the share of unspecified strokes (from 6.1% to 4.1%), unspecified cerebrovascular disease (from 8.2% to 3.0%), while the share of CVD consequences increased (from 6.6% up to 12.6%). Mortality decreased from 5.7% to 4.9%. Conclusion. The developed system of measures made it possible to reduce the CVD mortality during the COVID-19 pandemic. The medical effectiveness of this approach in terms of reducing mortality in relation to the entire range of measures used during this period in the Russian Federation equaled to 12.7%. The proposed approach made it possible to level out the CVD mortality in urban and rural population, get a higher reduction in the number of years of life lost, reduce the increase in the loss of labor potential, and lethality from CVD. Scope of application. The study results can be used by health executive authorities.

РАСПРОСТРАНЕНИЕ ИНФЕКЦИОННЫХ ЗАБОЛЕВАНИЙ И СМЕРТНОСТЬ СРЕДИ ГОРОДСКОГО НАСЕЛЕНИЯ СССР В ГОДЫ ВЕЛИКОЙ ОТЕЧЕСТВЕННОЙ ВОЙНЫ

The article examines the morbidity dynamics of the urban population during the Great Patriotic War. The year-to-year data on the number of cases of citizens with typhoid, typhus and recurrent typhus, malaria, dysentery, measles, scarlet fever, diphtheria, whooping cough, toxic dyspepsia, acute gastroenterocolitis are presented. The dynamics of these diseases during the war years is analyzed. A reduction in cases of gastrointestinal diseases is shown. In case of diseases with a predominantly airborne transmission mechanism there was adherence to natural cycles of morbidity changes, with a weak effect of medical measures on them. The spread of typhus was caused by the processes of evacuation and deportation, including prisoners of war. An increased proportion of urban morbidity with a number of infections is noted. The analysis of anti-epidemic activity of health care system is carried out. In accordance with the teachings of L. V. Gromashevsky, measures are identified against each of the links of the epidemic process. The sanitary activity of healthcare is considered, data on the scale of vaccination and phaging of the population are given, and the dynamics of hospitalization of patients is analyzed. Conclusions are drawn about the level of their effectiveness. Much attention is paid to the analysis of the mortality dynamics of infectious patients during the war years. The influence of morbidity dynamics on the change in the structure of causes of mortality, as well as the reduction of mortality of the urban population is determined. It is concluded that the change in the incidence rate during the war years, primarily with gastrointestinal diseases, as well as a decrease in mortality from them, became the basis for the formation of an endogenous mortality structure.