WHO Expert Research Articles

Assessment of the Relationship Between Bone Mineral Density and Fracture Risk Factors in the Family Doctor Practice

Osteoporosis is the fourth most common after cardiovascular, cancer and endocrine diseases. According to WHO experts, due to the aging population and the impact of negative environmental factors, the incidence of osteoporosis will increase further. The objective: determining the relationship between ultrasound densitometry data on the heel cyst and the risk of fractures in older women from different regions of the country. Materials and methods. The study was based on a survey of women in major cities of Ukraine – Kyiv, Kharkiv, Odessa. 116 women aged 40 to 79 years were included. The average age of the subjects was 56±9,62 years, the average body weight was 74,5±12,9 kg, height 163,1±5,62 cm, the average body mass index (BMI) was 28±4,90. Normal (BMI) 20–24,9 had 35 women (30,2%), rates of preobesity and clinical obesity were in 81 surveyed women (69,8%). All subjects were divided into 4 groups by age: 40–49 years, 50–59 years, 60–69 years, 70–79 years. Results. Decrease in bone mineral density was found in 59,5% of examined women, of which osteopenia was in 57%, osteoporosis in 2,5% of women, the norm in 40,5% of women. The number of women with low BMD increased with age. Analyzing the risk factors in women after 40 years revealed a high incidence of hypertension 40,5%, the frequency of previous fractures in the anamnesis was 22,% of respondents, fractures of the femur and other fractures in parents noted 33,6% of women, a decrease in growth by 3 cm during life occurred in 13,7%, early menopause (up to 45 years) in 16,3% of women. Physical activity less than 30 minutes a day was noted by 27,5%. The risk of FRAX and Q-fracture fractures is significantly correlated with densitometry. Conclusions. Early detection of osteoporosis risk factors in the practice of a family doctor will help prevent an epidemic of this disease in our country and will prevent negative medical and social consequences. All of the above should be considered for planning preventive measures for osteoporosis and its complications, as well as for subsequent diagnostic steps for early detection of the disease.

Biochemical and morphofunctional study of sperm of men infected with antibiotic-resistant strains of Ureaplasma urealyticum

Background: The role of UU in the pathogenesis of male infertility is currently not fully understood. Despite the widespread occurrence of antibiotic-resistant UU strains, there are virtually no data on their effect on the morphofunctional characteristics of the sperm and the biochemical parameters of the ejaculate. Aims: Comprehensive evaluation of the sperm fertility in men infected with antibiotic-resistant UU strains. Methods: The semen of men of active reproductive age (n=4752, age from 18 to 46 years, with the average age of 27.84.4 years) was studied. In the semen samples, UU was detected by the microbiological method (seeding on selective culture media with the subsequent identification and determination of the antibiotic sensitivity of the obtained isolates). The semen from men with mixed infections was excluded from the study. As a control, we used samples of ejaculates from healthy fertile men (n=67, age from 19 to 43 years, with the average age of 25.85.1 years). In the study of the ejaculate, the methods recommended by the WHO expert group were used. In addition to the standard spermogram, MAR tests (IgA, IgG and IgM) were performed, the degree of fragmentation of the sperm DNA was evaluated, the interaction of the sperm with hyaluronic acid was evaluated, as well, the activity of acrosine and neutral alpha-glucosidase was measured, the levels of zinc, citric acid, fructose and the level of glycodelin were determined. The study had been carried out between 2018 and 2021. Results: The most common resistance was to erythromycin (88.2%), less often to azithromycin (47.0%), tetracycline (41.7%). The resistance to doxycycline (7.7%), josamycin (5.9%), and medicamycin (5.8%) was relatively rare. In men infected with antibiotic-resistant UU strains, the most frequently observed anomalies of a standard spermogram were those of the motor characteristics of spermatozoa asthenozoo-spermia and those of the spermatozoa's morphology teratozoospermia. In the presence of polyresistant UU strains, a high degree of the sperm DNA fragmentation was more common (10.03% of cases) in respect to the cases of UU strains not resistant to antibiotics (5.92% of cases) or resistant to only one antibiotic (6.16% of cases). Abnormalities of the spermatozoa's interaction with hyaluronic acid were observed more often (more than 12% of cases) for antibiotic-resistant UU strains than for non-antibiotic-resistant UU strains (less than 4% of cases). In men infected with antibiotic-resistant UU strains, a decrease in the enzymatic activity of acrosin was often observed (29.71% of cases), most frequently among the cases with polyresistant strains (40.46% of cases). Conclusions: Antibiotic-resistant UU strains have a negative effect on the sperm fertility, of which the most pronounced negative effects are caused by polyresistant strains. We recommend measuring the acrosin activity when performing a spermogram for patients infected with UU. In the presence of polyresistant UU strains, it is advisable to assess the degree of the sperm DNA fragmentation. We recommend carrying out an antibioticogram before prescribing a treatment for ureaplasmosis.

Editorial introductions.

Editorial introductions.

In a War with the Virus: Science, People and Politics

The world, attacked by a malicious virus in the last quarter of the year 2019 termed it as SARS-CoV-2 (WHO) and manifestation of the ‘disease’ caused due to this virus was dubbed as COVID-19. Transmitting through respiratory-tract, it has already impacted millions of people, with a high mortality in vulnerable age groups. 
 It is reckoned that the outbreak of COVID-19 pandemic is a major public health concern with equally dire health consequences with critical environmental and economic impacts. Scientific community developed multiple vaccines and repurposed drugs for the COVID-19; however, the vaccination against this pathogen still throws a huge challenge of low uptake across the world. There are two dimensions to COVID-19 vaccination programme, i.e. ensuring equitable access and the positive behaviour change marketing strategies. 
 People acknowledge that this pandemic is primarily a ‘behavioural practices’ issue, including at community levels. The outrage of the ‘infodemic’ (spread of misinformation) is gaining currency especially through social media and digital space.
 The technical area of health communication has assumed a high-level of tilted ‘political communication’ in many countries. It is, therefore, time to witness more of science in politics than politics in science. 
 The article includes a key informant interview with a former WHO expert.

New WHO guidelines for cancer pain in adults and adolescents

In this article we performed publication analysis devoted to pain medicine in oncology during anticancer therapy and in palliative setting. Until recently, the main WHO guidelines for pain management in oncology were the recommendations of 1996, which included only pain relievers, as well as adjuvant and symptomatic drugs, which were applied according to the WHO analgesic ladder. These recommendations were based on the collective expert opinion of leading clinicians and scientists. The new WHO clinical guidelines were published in 2019. They are based on the principles of evidence-based medicine, including modern concepts of the etiology and pathogenesis of tumor pain syndrome. This recommendations contain sections on the analgesic efficacy of radiation therapy and antitumor drug therapy. The new WHO recommendations have not yet been published in Russian and are not sufficiently available for a wide range of oncologists and palliative specialists in our country. The purpose of this publication is to present within one volume a concise but complete and comprehensible discussion of the latest trends in pain therapy in oncology, published by WHO experts.

Гайк Хачатурович Шахбазян — організатор санітарно-гігієнічної справи, науковець, педагог, палкий патріот України (до 125-рiччя від дня народження)

In commemoration of the 125-th birth anniversary The creative pathway of Professor Haik Shakhbazian, including the stages of the formation and development of his personality from practical sanitary physician to scientific researcher, Director of the Institute and Head of the Department, as well as the WHO expert and Corresponding Member of the USSR Academy of Medical Sciences was investigated. The contribution of the scientist to physiology and labour hygiene, in particular to a new scientific direction –the hygiene of the industrial microclimate, founded by Professor Shakhbazian, has been analyzed. The stages of the scientist’s and teacher’s work at Kyiv Scientific Research Institute of Labour Hygiene and Occupational Diseases and at the Department of Labour Hygiene and Occupational Diseases in the Bohomolets Kyiv Medical Institute were studied. Monographs, textbooks, teaching materials, lectures of the scientist and his social activities were analyzed. The glorious traditions of the Professor Shakhbazian’s scientific school were continued by his numerous students.

Захворюваність населення України запальними захворюваннями пародонта, прогнозування та профілактика патологій в сучасних умовах

The purpose of the study. The article reflects the issues of the incidence of inflammatory periodontal diseases in the population of Ukraine, methods for predicting exacerbations of diseases for the timely conduct of secondary prevention. It has been established that the high prevalence of periodontal diseases among different groups of the population makes this problem one of the most important problems of modern dentistry. According to WHO experts, 80% of schoolchildren in different countries have periodontal pathology, and among adults it occurs in almost 100% of cases. Modern periodontal prophylaxis should be carried out on the basis of clinical examination of patients. Periodontal prophylaxis should be based on taking into account the identified etiological factors of the disease. Predicting the incidence of periodontitis and predicting the course of the disease is one of the most important problems of periodontology today. Solving forecasting problems in clinical, experimental and preventive medicine is one of the most difficult areas of the activity of doctors of various profiles. Materials and methods. In order to form a risk group, the occurrence of an exacerbation of inflammatory periodontal diseases for the timely implementation of secondary prevention of pathology, an algorithm for the probability of diseases and a mathematical model for predicting the course of the disease were developed. The use of this method made it possible to select 9 signs out of 42 that most significantly affect the prognosis of exacerbation in inflammatory periodontal diseases. Results and discussion. Based on the curves of the dependence of the frequency of the occurrence of exacerbation of inflammatory periodontal diseases on the magnitude of the risk of exacerbation of this pathology, 3 degrees of prognosis probability were determined: low, medium, high. The use of the method of stepwise discriminant analysis made it possible to develop a system for predicting the possibility of an exacerbation of inflammatory periodontal disease and to scientifically substantiate the principles of identifying risk groups for the possibility of exacerbation of inflammatory periodontal diseases in this group of examination. For patients with a risk of exacerbation, dynamic observation was established for one year, before the beginning of which they were divided into 2 groups – the study and control. Patients in the study group underwent preventive treatment, which included the appointment of an appropriate diet, work and rest regimen, correction of the state of the immune system using immunomodulatory drugs, treatment of concomitant diseases and local treatment of inflammatory periodontal diseases. Patients in the control group underwent conventional prophylaxis, which included adherence to general rules: a rational regimen, a balanced diet, rational oral hygiene, and basic sanitary and educational work. Conclusion. As shown by the results of dynamic observation, among patients of the study group, exacerbation of the disease was observed in 14.3% of cases, in patients of the control group – in 42.5%, which corresponded to the likelihood of an exacerbation of the disease by 94.5%

Religion and the World Health Organization: an evolving relationship

Much has been written about WHO. Relatively little is known, however, about the organisation’s evolving relationship with health-related personal beliefs, ‘faith-based organisations’ (FBOs), religious leaders and religious communities (‘religious actors’)....

The development of the WHO Labour Care Guide: an international survey of maternity care providers

BackgroundThe partograph is the most commonly used labour monitoring tool in the world. However, it has been used incorrectly or inconsistently in many settings. In 2018, a WHO expert group reviewed and revised the design of the partograph in light of emerging evidence, and they developed the first version of the Labour Care Guide (LCG). The objective of this study was to explore opinions of skilled health personnel on the first version of the WHO Labour Care Guide.MethodsSkilled health personnel (including obstetricians, midwives and general practitioners) of any gender from Africa, Asia, Europe and Latin America were identified through a large global research network. Country coordinators from the network invited 5 to 10 mid-level and senior skilled health personnel who had worked in labour wards anytime in the last 5 years. A self-administered, anonymous, structured, online questionnaire including closed and open-ended questions was designed to assess the clarity, relevance, appropriateness of the frequency of recording, and the completeness of the sections and variables on the LCG.ResultsA total of 110 participants from 23 countries completed the survey between December 2018 and January 2019. Variables included in the LCG were generally considered clear, relevant and to have been recorded at the appropriate frequency. Most sections of the LCG were considered complete. Participants agreed or strongly agreed with the overall design, structure of the LCG, and the usefulness of reference thresholds to trigger further assessment and actions. They also agreed that LCG could potentially have a positive impact on clinical decision-making and respectful maternity care. Participants disagreed with the value of some variables, including coping, urine, and neonatal status.ConclusionsFuture end-users of WHO Labour Care Guide considered the variables to be clear, relevant and appropriate, and, with minor improvements, to have the potential to positively impact clinical decision-making and respectful maternity care.

Assessment of the prevalence of risk factors for chronic non-communicable diseases among employees of the North-Eastern Federal University

Introduction. According to WHO experts, chronic non-communicable disease (NCD) is the leading worldwide medical and social problem. In recent decades, the Republic of Sakha (Yakutia) population showed changes in nutrition habits, physical activity reduction. It increased the spread of modified chronic NCD’s risk factors. Material and methods. The authors performed a one-stage study of modified risk factors and frequency analysis of chronic NCD in the North-Eastern Federal University (NEFU) employees who had medical check-ups in 2017 (n = 800): men (n = 260), women (n = 540). The attendees’ age varied from 30 to 54 years. Abdominal obesity (AO) was diagnosed by two criteria: men’s waist ≥ 90 cm and women’s waist ≥ 80 for Asia residents (IDF1); men’s waist ≥ 94 cm and women’s waist ≥ 80 for European residents (IDF2) (IDF, 2006). Results. This analysis of the study group of NEFU employees showed the median level of SYS and DYS, glucose in serum, and the waist index in both groups, regardless of gender, to be within reference values. The most frequent risk factors of chronic NCD were hypercholesterolemia and abdominal obesity (p = 0.000). A spread of hypercholesterolemia was 16.8%, in men (23.5%) more frequently than in women (13. Every fourth woman and every third man had AO according to IDF criteria compared to attendees without AO (p = 0.000). Conclusion. A significant positive correlation between AO and age, SYS, DYS, cholesterol and glucose in serum was identified.

ОЦЕНКА РЕЗУЛЬТАТОВ СОЦИАЛЬНО-ГИГИЕНИЧЕСКОГО ОБСЛЕДОВАНИЯ СЕЛЬСКОГО НАСЕЛЕНИЯ ЮГА ТЮМЕНСКОЙ ОБЛАСТИ

Subject. The study of the sanitary culture of rural population is an information and analytic base for the development and implementation of activities concerning the primary prevention of dental diseases on the territories of southern rural areas of Tyumen region.
 The aim is to estimate the social and hygienic level of skills in the population of Jurga district of Tyumen region. 
 Materials and methods. The investigations were carried out using expeditionary and exploratory method. 200 men living in Jurga district took part in the questionnaire. The standardized questionnaire regarding the oral health developed by WHO experts (2013) was used. All men were divided according to the gender and age [at the age of 12 (n=69), at the age of 15(n=31), at the age of 35-44 (n=67), at the age of 65 and older (n=33)]. According to the data received the portrait concerning social and hygienic skills was made up for each age group. The results were processed using analytic program «Vortex 10.7.3». 
 Results. The analysis of the received data revealed the low level of social and hygienic skills in the population of all aged groups living in Yurga district. The conducted medical and sociological questionnaire of population showed that the significant part of the population does not have knowledge of the choice of hygienic objects as well as the insignificant volume of skills of the individual oral hygiene. Also they do not have the necessity of carrying out preventive measures, dynamic check up of the oral health. Besides, the education of the population also plays a great role in the prevention of dental diseases. The tendency to the high motivation of carrying out the preventive measures was revealed in the persons having high education.

Study of the chemical composition of quinoa of Russian selection grown in the South of Russia

According to WHO experts, almost all countries have a shortage of dietary protein, which is about 25 million tons. This fact causes a high risk to human health, expressed in changes in the quality of its physiological processes. Most of the world’s scientists conduct scientific research to find natural raw sources of biologically complete protein. It is promising to use pseudo-grain quinoa culture as such source, which was awarded the title of the ideal product of the XXI century because of its amino acid composition. We conducted research on quinoa of Russian selection grown in the southern part of Russia. It was found that the coefficient of difference of amino acid scores (CDAS) of quinoa protein, showing an excess number of essential amino acids that are not used for plastic needs, is 9.86 %. With the CDAS evaluated the biological value (BV) of quinoa proteins, which is equal to 90.14%. Experimental data confirmed the nutritional value of quinoa of Russian selection. It can be recommended as a functional source of not only balanced amino acid composition of protein, but also minerals, vitamins, in particular magnesium, calcium, phosphorus, water-soluble vitamins B1, B2, C and fat-soluble vitamin β-carotene.

Peculiarities of the influenza and ARVI viruses circulation during epidemic season 2019-2020 in some regions of Russia

The surveillance of influenza viruses in ARVI structure and study of their properties in epidemic season 2019-2020 in Russian Federation are actual for investigations due to tasks of Global Influenza Strategy initiated by WHO in 2019. The data of epidemiological surveillance on influenza- and ARVI-associated morbidity and hospitalization in different age groups of population were analyzed; virological, genetic and statistical methods were used. Preschool children were involved in epidemic the most. Meanwhile, the highest rate of hospitalization was observed in patients of 18-40 years old. Influenza A(H1N1)pdm09 virus dominated in etiology of ARVI in hospitalized patients and pneumonia. The role of respiratory viruses in severe cases of pneumonia and bronchoalveolar syndrome in children was shown. The differences in spectrum of circulating viruses caused ARVI in different regions of Russia were found. Influenza A(H1N1)pdm09 and B/Victoria-like viruses were the main etiological agents that caused of epidemic; its activity among all ARVI was 7.3 and 8.0%, respectively. The differences in antigenic properties of influenza A(H3N2) and B epidemic strains compared to vaccine viruses were found. The populations of epidemic strains were presented by following dominant genetic groups: 6B1.A5/183P for A(H1N1)pdm09, 3С.2а1b+137F for A(H3N2) and V1A.3 line B/Victoria-like for B viruses. The good profile of epidemic strains susceptibility to anti-neuraminidase inhibitors has been saved. The most of the studied influenza strains had the receptor specificity characteristic of human influenza viruses. Obtained results identified the peculiarities of viruses caused the influenza and ARVI in epidemic season 2019-2020 in different regions of Russia. These results suggested the important role of influenza A(H1N1) pdm09 in severe cases and pneumonia in adults 18-40 years old. The continuing drift in influenza viruses was found, which, apparently, could not but affect the efficacy of vaccine prophylaxis and was also considered in the recommendations of WHO experts on the composition of influenza vaccines for the countries of the Northern Hemisphere in the 2020-2021 season.

Strengthening the primary health care response to COVID-19: an operational tool for policymakers.

The aim of this paper is to introduce an operational checklist to serve as a tool for policymakers in the WHO European Region to strengthen primary health care (PHC) services and address the COVID-19 pandemic more effectively and to present the results from piloting the tool in Armenia. PHC has the potential to play a fundamental role in countries' responses to COVID-19. However, this potential remains unrealized in many countries. To assist countries, the WHO Regional Office for Europe developed a guidance document - Strengthening the Health Systems Response to COVID-19: Adapting Primary Health Care Services to more Effectively Address COVID-19 - that identifies strategic actions countries can take to strengthen their PHC response to the pandemic. Based on this guidance document, an operational checklist was developed to serve as a tool for policymakers to operationalize the recommended actions. The operational checklist was developed by transforming key points in the guidance document into questions in order to identify potentially modifiable factors to strengthen PHC in response to COVID-19. The operational checklist was then piloted in Armenia in June 2020 as part of a WHO mission to provide technical advice on strengthening Armenia's PHC response to COVID-19. Two WHO experts performed semi-structured, face-to-face interviews with nine key informants (both facility managers and clinical staff) in three PHC facilities (two in a rural and one in an urban area).The data collected were analyzed to identify underlying challenges limiting PHC providers' ability to effectively and efficiently respond to COVID-19 and maintain essential health services. The paper finds that making adjustments only to health services delivery will be insufficient to address most of the challenges identified by PHC providers in the context of COVID-19 in Armenia. In particular, strategic responses to the pandemic were missed, due, in part, to the absence of COVID-19 management teams at the facility level. Furthermore, the absence of PHC experts in Armenia's national pandemic response team meant that health system issues identified at the facility level could not easily be communicated to or addressed by policymakers. The checklist therefore helps policymakers identify critical challenges - at both the facility and health system level - that need to be addressed to strengthen the PHC response to the COVID-19 pandemic.

Successful Implementation of Integrated Care in Slovenian Primary Care.

For the purpose of celebrating the 40th anniversary of Alma Ata declaration, the WHO published a successful model of integrated patient care being performed in Slovenia. After two years, the WHO experts evaluated the success in practise during a visit to the Slovenian primary care environment. This report showed that Slovenia was a notable exception regarding developing effective primary care systems. The country has an impressive primary care which performs very well.

To the problem of excessive alcohol consumption in Russian families

The article is devoted to the analysis of alcoholism in Russian families. The author gives a brief excurse into the history of alcohol consumption, dispels the myth that the Russian people never controlled consumption of alcoholic beverages. The work, relying on the latest statistics, demonstrated that despite the emerging positive trends in this area, the level of alcohol consumption (especially strong alcohol) in Russia is still very high and significantly exceeds the conditionally safe norm indicated by the WHO experts. It negatively affects the life expectancy of the Russian population, especially among men of working age. However, if previously alcoholism was predominantly masculine, today this type of addiction is becoming gender-neutral and women drink on a par with men, which will inevitably lead to an increase in mortality from alcohol-related causes among them.Particular attention is paid to the problems of families facing the problem of alcoholism among one or several of their members. It is emphasized that children are the most vulnerable in this situation because of their dependence on adults — they are not able to change the situation and are forced to live in constant conflict, stress and ill-treatment. The author notes that the violence to which not only children, but also other family members are subjected to in alcoholic families, is far from rare and extremely dangerous.The paper addresses the issue of the influence of alcoholism of adult family members on children's health. Children of dependent parents are often born sick and lag behind in physical and mental development. This is further aggravated by upbringing in an atmosphere of alcoholism, which leads to the fact that the younger generation perceives excessive alcohol consumption as the norm, adopts the habits of parents and also become dependent. Children of drinking parents also experience many complexities of a personal and interpersonal nature and are prone to auto-aggressive behavior.In conclusion, the author addresses the problem of social orphanhood arising from alcohol abuse by parents, as well as its consequences.The empirical part of the work is based on data from the World Health Organization, the Federal State Statistics Service, the Public Opinion Foundation and the All-Russian Center for the Study of Public Opinion.The article will be of interest to specialists in the field of sociology of family and health, prevention of addictive behavior, rehabilitation of people with addictions, and students of relevant specialties.

Comperative Study on the Intervention of ‘Spice ‘ Mixture (SM) Prepared by Natural Food Additives (NFA) Alone or Intervention of SM with Mind Calming Exercise in the Management on Female Obesity

Obesity has become huge health problem in the entire world. In Sri Lanka, the prevalence of obesity is estimated to be 20.3% in men and 36.5% in women in four provinces. Further, the highest prevalence rate in Western Province, especially in Colombo was estimated to be 32.2%, among adults. Obesity is associated with osteoarthritis, obstructive sleep apnea, gall stones, and hiatus hernia. In addition to this obesity is related to numerous other problems, such as menstrual and mental disorders and varicose vein etc. According to the concept of Unani four treatment modalities are there; they are known as Dieto therapy (Ilaj Bil Ghiza), Pharmaco therapy (Ilaj Bil Dawa), Regimental therapy (Ilaj Bit Tadbeer) and Surgery (Ilaj Bil Yad). Biomarkers such as Lipid profile (VLDL, LDL, HDL And Serum triglycerides), Haemoglobin percentage, SGPT and SC (Serum Creatinine) were considered. Blood sample analysis was performed at NATH (National Ayurvedic Teaching Hospital), Borella, National Diabetic Centre, Rajagiriya and Asiri Hospitals Ltd. According to Unani or Greco-Arabic medical concept, improper digestion may play a main role to cause obesity. Improper digestion was corrected by using a ‘spice’ mixture made by Natural Food Additives (NFA), which possesses the actions of carminative, digestive and strengthens the gastro-intestinal tract. The preparation of ‘spice’ mixture included Natural Food Additives (NFA). They are Cumin (Cuminum cyminum), Garlic (Allium sativum), Curry Leaves (Murraya koenigii), Ceylon Cinnamon (Cinnamomum zeylanicum) and Black Pepper (Piper nigram). Studies revealed that waist circumferences (WC) is closely linked to CV disease risk factors. Also, WHO Expert Committee on Obesity in Asian and Pacific populations suggested that revised cutoff points for WC: 90 cm for men and 80 cm for women to identify patients with abdominal obesity. South Asians are more prone to insulin resistance and dyslipidaemic state of abdominal obesity. Study concluded that the intervention of ‘spice’ mixture reduces obesity and the effective mind calm exercises would give more beneficial effect in weight reduction.

An Analytical Study on Anemia in Rural Population

Background: Anemia is one of the common Hematological disorders in India and worldwide. It affects all the age groups both in Males and Females. Moderate to Severe Anemia causes increased morbidity and mortality in elderly patients (AWHO expert group) - According to Worlds Health Organization, Anemia is a define when adults males are having Hemoglobin less than 13.5gr% when adults females non-pregnant less than 12 gr% and when pregnant females are having less than 11 ger%. The incidence of Anemia is very high in old age people who are more than 75 years of age. It ranges from 9% to 41%. In India Anemia is commonly due to nutrition, pregnancy, Hookworm infestation, DUB in the case of females, and Malignancy. The prevalence of anemia in the elderly has been found to range from 9% to 42% with the highest prevalence in 80 years and above. The common causes of anemia in India are Nutritional, Pregnancy, Hookworm infestation, and DUB in the case of Females and Malignancy. The common symptom is General weakness, Fatigue, Lack of concentration, Shortness of Breath, and Palpitations. A WHO expert group proposed that anemia should be considered when hemoglobin level below 13.5gr& in adult males; 12gr% in adults females non-pregnant; 11 gr% in adult female pregnant; 12gr% in children over 14yrs(1). The aim is to evaluate the etiology and clinical features of anemia in adults in rural medical colleges. Subjects & Methods: This study is conducted at GEMS Medical College, Srikakulam, A.P for the period of 1 year from April 2018 to March 2019. This study includes 120 patients with Anemia. The age group is between 20 years and 70 years. Males were 56 and females were 64. Results: We have conducted this study at GEMS Medical College, Srikakulam for 1 year, from April 2019 to March 2019 total no. of patients included in this study are 120 males 56 and females 64. The age group is between 20 years and 70 years. The maximum patients are in between 30 years and 70 years in both sexes. Conclusion: Anemia is a common medical problem in developing countries. In a rural part of India, the disorders will complicate the pregnancy also. So periodical examination and education of the people can decrease morbidity and mortality. In our area still, the common cause is nutritional.

Establishment of transfusion-relevant bacteria reference strains for red blood cells.

Red blood cell concentrates (RBCC) are susceptible to bacterial contamination despite cold storage. A reliable evaluation of strategies to minimize the risk of RBCC-associated bacterial transmission requires the use of suitable reference bacteria. Already existing Transfusion-Relevant Bacteria Reference Strains (TRBRS) for platelet concentrates fail to grow in RBCC. Consequently, the ISBT TTID, Working Party, Bacterial Subgroup, conducted an international study on TRBRS for RBCC. Six bacterial strains (Listeria monocytogenes PEI-A-199, Serratia liquefaciens PEI-A-184, Serratia marcescens PEI-B-P-56, Pseudomonas fluorescens PEI-B-P-77, Yersinia enterocolitica PEI-A-105, Yersinia enterocolitica PEI-A-176) were distributed to 15 laboratories worldwide for enumeration, identification, and determination of growth kinetics in RBCC at days 7, 14, 21, 28, 35 and 42 of storage after low-count spiking (10-25CFU/RBCC). Bacterial proliferation in RBCC was obtained for most strains, except for S. marcescens, which grew only at 4 of 15 laboratories. S.liquefaciens, S.marcescens, P.fluorescens and the two Y.enterocolitica strains reached the stationary phase between days 14 and 21 of RBCC storage with a bacterial concentration of approximately 109 CFU/ml. L.monocytogenes displayed slower growth kinetics reaching 106 -107 CFU/ml after 42days. The results illustrate the importance of conducting comprehensive studies to establish well-characterized reference strains, which can be a tool to assess strategies and methods used to ameliorate blood safety. The WHO Expert Committee on Biological Standardization adopted the five successful strains as official RBCC reference strains. Our study also highlights the relevance of visual inspection to interdict contaminated RBC units.

Attention to the details: childbirth without stress and aggression

Background. Perinatal obstetrics involves the interests of both the mother and the fetus. The main sections of perinatal obstetrics are prenatal diagnosis, intensive care during pregnancy and childbirth, choice of optimal delivery way, resuscitation and care of the newborn. WHO experts believe that the comfort of the mother, psychological support of relatives, adequate analgesia, lack of aggressive delivery (unreasonable opening of the amniotic sac or unreasonable labor stimulation), monitoring of the childbirth dynamics and even the pose of the woman during labor are extremely important.
 Objective. To describe the modern views on childbirth.
 Materials and methods. Analysis of literature data on this issue.
 Results and discussion. Current trends in childbirth include the increase of the average weight of the fetus, of the number of high-risk mothers, of childbirth duration, of the incidence of traumatic injuries of the birth canal, of the frequency of surgical interventions. Obstructive labor is often accompanied by the aggressive management: hyperactive actions of obstetricians and gynecologists, uncontrolled use of oxytocin, any action in immature cervix. In obstructive labor, the obstetric situation should be assessed by vaginal examination and/or transabdominal ultrasound (US). If the latter does not show the middle structures of the head, one can combine transabdominal and transperitoneal US. With regard to birth injuries, their prevention should begin several weeks before the expected date of birth to reduce the risk of episiotomy and spontaneous perineal rupture. To do this, there are special vaginal hydrogels that reduce friction during childbirth. The composition of the hydrogel Ginodek (“Yuria-Pharm”) includes an antiseptic component (decamethoxine 0.02 %), a regenerating component (hyaluronic acid 0.5 %) and a component that regulates the vaginal pH (lactate buffer). Decamethoxine has bactericidal, viricidal, fungicidal, anti-inflammatory, desensitizing and antispasmodic action. Lactate buffer eliminates the symptoms of acid-base imbalance, helps to moisturize the vaginal mucosa and to maintain normal microflora. Hyaluronic acid restores the water balance of cells, promotes the entry of nutrients into the cells and the excretion of metabolic products, stimulates regeneration. Indications for the use of Ginodek include the prevention of infectious complications in obstetrics and gynecology before surgery, minor diagnostic operations, abortion, childbirth, intrauterine device insertion, as well as treatment of genital infections and conditions accompanied by dryness and atrophy of the vaginal mucous membrane.
 Conclusions. 1. When conducting childbirth in a natural way, the comfortable condition of the woman in labor, psychological support of relatives, adequate anesthesia, and the absence of aggressive assistment are of great importance. 2. There are vaginal hydrogels that prevent birth injuries via reducing the friction during childbirth. 3. Ginodek hydrogel, which contains decamethoxine, hyaluronic acid and lactate buffer, helps to reduce the number of birth injuries.