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Background: Primary immunodeficiencies (PIDs), now known as inborn errors of immunity, are a group of inherited diseases caused by defects in the genes that control the immune response. Patients with PIDs have risks of developing a severe course and/or death in COVID-19. Passive immunization with long-acting monoclonal antibodies (MABs) to SARS-CoV-2 should be considered as pre-exposure prophylaxis in patients with PIDs. Tixagevimab/cilgavimab is a combination of MABs that bind to the SARS-CoV-2 spike protein., Aim: To evaluate the efficacy and safety of pre-exposure prophylaxis of new SARS-CoV-2 infection in PIDs with the combination of tixagevimab/cilgavimab., Materials and Methods: Forty eight patients diagnosed with PIDs were included in the study. Median follow-up after drug administration was 174 days. The total number of confirmed coronavirus infections in patients with PIDs as well as 6 months before and after administration of MAT were assessed., Results: In the analyzed cohort, the overall incidence of COVID-19 from pandemic onset to MABs administration was 75% (36/48), with 31% (11/36) of over-infected patients having had the infection more than once. The incidence of COVID-19 immediately 6 months before the introduction of tixagevimab/cilgavimab was 40%. All patients who had COVID-19 after pre-exposure prophylaxis had a mild infection. The incidence of COVID-19 6 months after tixagevimab/cilgavimab administration significantly decreased compared to the incidence 6 months before administration (7 and 40%, respectively; p <0.001)., Conclusion: The use of tixagevimab/cilgavimab in patients with PIDs is effective as pre-exposure prophylaxis and reduces the risk of severe COVID-19.

Aim: To determine factors of adherence to treatment in patients with ulcerative colitis (UC)., Materials and Methods: The study was performed in the department of treatment of inflammatory bowel diseases in Loginov Moscow Clinical Scientific Center from 2019 till 2021 years by surveying 1089 patients with UC. This analysis revealed patients with high adherence (HAP) and low adherence to treatment (LAP)., Results: In the survey analysis was determined, that there were more low-adherence patients, than high-adherence patients [596 (59.6%) and 404 (40.4%), respectively, (p0.001)]. In the group of HAP (100%) were 297 women (73.5%) and 107 (26.5%) men (p0.001). Also in this group prevailed patients with duration of disease more 5 years 305 (75.5%) and extraintestinal manifestations 261 (64.6%); p0.001. In the group of LAP (100%) were more patients younger 44 years, with bad habits and who did not follow diet (p0.001). The rate of UC reccurence more than 1 time per year was higher in LAP group 430 (72.1%), versus 137 (33.9%) patients in HAP (p0.001). The frequency of surgical procedures in UC patients was significantly higher in LAP 12 (2.0%) in comparison with 2 (0.5%) in HAP group (p0.001)., Conclusion: In our study was determined, that among UC patients, examined in the department of inflammatory bowel diseases, 60% patients had low adherence to treatment. High adherence to the treatment is statistically significantly associated with female gender, family accommodation, non-working patients, extraintestinal manifestations, additional medical maintenance. Low adherence to the treatment is associated with steroids, male gender, age less than 44 year, bad habits (smoking, alcohol consumption), higher education, complicated UC and frequency of reccurences.

On June 2325, under the auspices of the Year of Science and Technology in Russia, the 17th International Interdisciplinary Congress of Allergology and Rhinosinusitis was held in Moscow. The 17th International Interdisciplinary Congress of Allergology and Immunology, where the results of current research, approaches to therapy and prevention of diseases based on modern clinical guidelines were presented. The event included a symposium "Breathe freely it is possible! How to help patients with bronchial asthma and polyposis rhinosinusitis?" with the participation of leading Russian specialists.

Aim: In a retrospective study, we evaluated factors associated with the early development of septic shock in patients with severe COVID-19., Materials and Methods: We collected medical records of the intensive care unit patients submitted by the local COVID-19 hospitals across Russia to the Federal Center for the Critical Care at the Sechenov First Moscow State Medical University (Sechenov University). Septic shock in crticially ill patients requiring mechanical ventilation was defined as a need in vasopressors to maintain blood pressure., Results: We studied 1078 patients with severe COVID-19 who were admitted to the intensive care units for respiratory support. There were 611 males and 467 females. The mean age was 61.013.7 years. Five hundred twenty five medical records (48.7%) were received from the Moscow hospitals, 159 (14.7%) from the Moscow region, and 394 (36.5%) from the hospitals located in 58 regions of the Russian Federation. In 613 (56.9%) patients, diagnosis of SARS-CoV-2 infection was confirmed by PCR, and in the other cases it was established on the basis of the clinical picture and the results of the chest CT scan. Septic shock developed in 214 (19.9%) of 1078 patients. In the logistic regression model, the risk of septic shock in patients older than 50 years was higher than in patients of a younger age (OR 2.34; 95% CI 1.533.67; p0.0001). In patients with more severe SARS-CoV-2 infection, there was an increase in the prevalence of cardiovascular diseases, including coronary heart disease and atrial fibrillation, type 2 diabetes and malignant tumors. The risk of septic shock in patients with three or more concomitant diseases was higher than in patients without any concomitant chronic diseases (OR 1.76; 95% CI 1.762.70)., Conclusion: The risk of septic shock in patients with acute respiratory distress syndrome induced by SARS-CoV-2 is higher in patients older than 50 years with concomitant diseases, although a severe course of the disease is also possible in younger patients without any concomitant disorders.

Aim: To present the results of work of National Medical Research Center of Treatment and Rehabilitation, reassigned for COVID-19 patients treatment during pandemic. Run-up methodology, procedures and working process organization are detailed., Materials and Methods: 354 COVID-19 patients were treated from 13.04.2020 to 10.06.2020 [age 59 (470) years, 56% women, body mass index 28.5 (24.932.2) kg/m2]. Patients were admitted at 8 (611) day of sickness. In-hospital stay was 16 (1420) days., Results: NEWS scale at the day of admittance was 2 (14); 2 (13) in patients discharged alive and 6 (47) in died patients, p=0.0001. So prognostic accuracy of NEWS scale was confirmed as very well (area under ROC-curve = 0.819). 69 patients (19.5%) were treated at intensive care department for 7 (413) days. 13 patients died, 11 of them had COVID-19 as direct or indirect cause of death. Total in-hospital mortality was 3.67%, in-hospital mortality of COVID-19 patients 3.1%. 17 healthcare workers (HCW), contacted with COVID-19 patients were infected (2.67%). 4 HCW, who had no direct contact with patients were also infected and 7 HCW were infected before the first patient was admitted. No one of them died., Conclusion: Complex tasks of healthcare organization during COVID-19 pandemic can be solved quickly with acceptable quality, characterized by low levels of patients; mortality and HCW infection.

Aim: To study the epidemiology of multiple myeloma in the city of Moscow and compare the results obtained with data from similar studies in other countries., Materials and Methods: The study is based on information from a database of case histories of 3942 patients suffering from symptomatic MM, residents of the city of Moscow, which is maintained at the Hematologic Moscow City Center of S.P. Botkin Municipal Clinical Hospital. The control of the completeness of inclusion was carried out by cross - comparison with the data of the Moscow Cancer Register and the Register of Program 7 (beginning in 2019 - 12) of Highly Expensive Nosologies. The assessment was made according to data as of January 1, 2019. The calculations were carried out taking into account the data of Rosstat at the beginning of 2019 on the population of Moscow in different gender and age categories., Results: Among the 3942 patients with active MM 1707 men - 43% and 2241 women - 57%, the median of the current age was 68 (28-94) years. The median time of observation of patients since the diagnosis of the disease 34 (1-423) months. The peak incidence was in the age range of more than 60 years. There were no significant differences in gender ratio in different age strata with a breakdown of 10 years. The number of cases of newly diagnosed MM per year for the period from 2009 (n=219) to 2018 (n=385) increased by 75.8%. At the same time, the demonstrated increase in the incidence rate for the described period turned out to be fair only for groups of patients over 50 years old, with the maximum increase in this indicator over the described period in the age range of 60-69 years. This is mainly due to the increase in life expectancy in Moscow in recent years. The study demonstrated that over the past 10 years, the average annual mortality rate from MM has decreased in Moscow, and as a result, its prevalence has increased. The rate of 2-year overall survival of patients with MM was 76%, 5-year - old - 49%, 10-year - old - 27%. The median overall survival of patients under the age of 65 when diagnosing the disease was 79 months, and 48 months. The distribution of patients within international classifications was consistent with international data., Conclusions: The study revealed a significant dynamic of the epidemiological situation concerning MM in Moscow. Over the past 10 years there has been an increase in the incidence of MM, as a result of an increase in the life expectancy of the population. The use of modern diagnostics and therapy of MM in real clinical practice has led to a significant reduction in mortality. Due to these factors, an increase in the prevalence of MM in Moscow has taken place, and this process will no doubt progress in the future.

Aim: To compare the clinical manifestations of ankylosing spondylitis (AS) and non-radiographic axial spondyloarthritis (nrAxSpA)., Subjects and Methods: A Moscow early spondyloarthritis cohort has now included 132 patients with axial spondyloarthritis, of whom 69 patients who have been followed up at least 12 months are to be involved in a preliminary analysis. The mean age at the time of inclusion in the study was 28.1±5.5 years; the mean disease duration was 24.7±15.8 months; 63 (91.3%) patients were HLA-B27 positive; 41 and 28 included patients were diagnosed with AS and nrAxSpA, respectively., Results: Men were significantly more in the AS group than in the nrAxSpA group (58.5 and 32.1%, respectively; p=0.05). The patients of the two groups did not differ in main clinical parameters (the presence of arthritis and enthesitis), disease activity (BASDAI, ASDAS-CRP) and functional status (BASFI). All indicators of inflammatory activity decreased nearly 2-fold in both groups after 12 months of follow up. In 7 (25%) patients with nrAxSpA, radiologically detectable sacroiliitis (SI) developed over 12 months and the diagnosis of AS was verified. Among them, 2 (28.5%) patients had initially active SI detected by magnetic resonance imaging (MRI); 4 (57.1%) had chronic SI, and 1 (14.4%) had no pathological MRI changes., Conclusion: Due to the fact that the clinical manifestations of AS and nrAxSpA are comparable, it can be assumed that the latter is an early stage of AS.

The authors give their own data in the first Russian publication on 170 patients with lymphomas and hepatitis concurrent with HIV infection, on the distribution of therapy regimens by nosological entities and the number of deaths. Conventional protocols and programs were used for diagnosis and treatment. All the patients received highly active antiretroviral therapy. Lymphoma was treated according to the conventional programs using rituximab in people without hepatitis B. Aggressive lymphomas, such as diffuse large B-cell lymphoma, Burkitt lymphoma, and plasmablastic lymphoma, were identified in most patients. Hodgkin's lymphoma is the matter of a separate study; it differs in its pathogenesis from other lymphomas. The rate of coinfection with hepatitis was high in the entire group of patients with lymphomas. The major prognostic indicators included low CD4 T-cell counts (less than 50), stage IVB lymphoma, and hepatitis. Complete remissions were achieved in 40% of patients. Forty-one (24%) patients died.

Aim: To estimate the incidence of acute myeloid leukemias (AML) in Moscow adults and to evaluate the efficiency of their treatment., Subjects and Methods: Data on Moscow residents who were first diagnosed with AML in 2010 were retrospectively collected. The efficiency of their treatment was evaluated from the rates of complete remissions (CR), recurrences, deaths, and 4-year overall (OS) and relapse-free survival (RFS). The data as of September 1, 2013, were analyzed., Results: According to the 2010 pooled materials of the city's municipal hematology departments, AML (non-M3 types) was diagnosed in 286 patients whose median age at diagnosis was 64.9 years (range, 18.2-92.0 years). The notified incidence rate was 2.9 (3.3 for men and 2.6 for women) cases per 100,000 population. 118 (41%) patients received intensive chemotherapy (ICT); 119 (42%) had chemotherapy with low-dose cytarabine (LDC); 7 (2%) had that with hypomethylating agents (HA); and 42 (15%) had palliative therapy (PT). During first-line therapy, none of the patients underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT). In the entire group, the early (within the first 60 days) mortality rates were 42% (119 deaths); that of patients with primary refractory disease was 32% (90 deaths). CR was achieved in 77 (27%) patients: 57 (48%) on ICT, 17 (14%) on LDC, and 3 (43%) on HA. Recurrences occurred in 37 (48%) of the 77 patients who had achieved CR at a median follow-up of 43.9 months. Four-year OS in all the patients receiving PT was 9.8±1.9% (18.2±3.9% in the patients on ICT versus 4.5±2% in those of LDC; p=0.028); 4-year RFS was 36.1±5.7% (39.6±6.7% inthe patients on ICT versus 31.3±11 .6% in those on LDC; p=0.8)., Conclusion: High mortality rates in the induction, which are caused by the limited resources of accompanying therapy, poor sanitary conditions, and no own opportunities to perform allo-HSCT, remain a key problem of AML therapy in adults.

Aim: To assess follow-up study results in human immunodeficiency virus (HIV)-infected patients with prior cerebral toxoplasmosis (CT)., Subject and Methods: Follow-up study results were assessed in HIV-infected patients with prior CT., Results: The fate of only 97 out of 137 (66% of the hospitalized) patients discharged from hospital is known, as 40 convalescents have been lost to follow up. Thereafter, relapses developed in 19 patients, of whom 6 died. Eleven more patients with HIV infection died due to its progression and development of other secondary lesions. Five more patients died from narcotic overdose, staphylococcal sepsis, and acute pancreatic necrosis. The main peak of fatal outcomes was within the first 2 years after discharge. 3.5-year survival rates after TC were 75%. The causes of recurrent and progressive HIV infection were non-compliance with secondary prevention of CT and low adherence to an antiretroviral therapy regimen, the blame of which fell not only on the patients, but also their attending physicians and specialists who had advised how to enhance treatment motivation., Conclusion: Further follow-up of convalescent CT patients calls for closer attention to the possible development of recurrences within the first three years after discharge in particular, regardless of CD4 cell counts.

Aim: To estimate the prevalence of some modified cardiovascular risk factors (RFs) among the students of two Moscow higher education institutions to further test the technology of individual medical prevention counseling., Subjects and Methods: A questionnaire survey was conducted among 1912 first-year students (boys and girls, mean age 17.7 years) from 2 Moscow higher education institutions to reveal physical activity levels, smoking status, alcohol abuse, and food addictions., Results: Almost one third of the students (mainly girls) lead a sedentary lifestyle. The mean age at onset of smoking is 14.8 years. At the moment, the smoking students are 22% (28% of boys and 18% of girls). 12.2% of the respondents have moderate and high nicotine dependence. Most smokers demonstrate low motivation to give up smoking. The mean age for alcohol consumption is 15.8 years. 60% of the students use alcohol. There are no great differences in the drinking of alcoholic beverages between the girls and boys. 18% of the study sample students eat irregularly. Nearly 50% of the students add salt to cooked foods. 17% of the students eat too much sugar; more than 50% take sugar- and fat-laden foods. 54% of the students use vegetables and fruits insufficiently., Conclusion: Among all the modified cardiovascular RFs, alcohol use and irrational nutrition are most common among the students. Smoking and low physical activity are also relevant problems although these indicators among the students of Moscow are lower than among those in other regions of the Russian Federation. The found patterns call for the increased attention of the administrations of higher education institutions.

Aim: To identify the meteorological factors or their combinations, which are most significant for the development of acute coronary syndrome (ACS) in different seasons., Subjects and Methods: A Statistica package was used to make an exploration analysis of the data of the A.S. Puchkov Central Emergency Medical Care Station on 63,412 admissions of patients diagnosed with acute myocardial infarction (AMI) to Moscow hospitals in 2009-2012 and those of the Hydrometeorology Center of Russia on weather conditions in the period under study., Results: Among the 63,412 patients, there were more men than women (p < 0.000005). Two long frost periods and three long abnormal heat periods were recorded in 2009-2012. In summer, the number of patients with a prehospital diagnosis of AMI was an average 19-22% less than in the other seasons. There was no peak in the number of hospitalizations during the abnormally hot summer of 2010. Air temperature proved to be a factor that was most strongly associated with the trend in AMI hospitalizations in men (MS = 1011.52, MSor = 27.27; p < 0.00005) and women (MS = 895.36, MSor = 25.37; p < 0.00005). The number of hospitalizations was negatively associated with daily average temperature in its positive range. In summer, the interdaily temperature difference turned out to be statistically significant; the highest number of hospitalizations was noted when it grew 6 °C colder. On days off, the number of admitted patients was 25% less than that on weekdays., Conclusion: The trend in hospitalizations for a referral diagnosis of AMI has a significant seasonal component. Their number was minimal in summer, including in the abnormally hot summer of 2010. Air temperature is the most important factor. Positive temperature was found to be strongly negatively correlated with diagnosed AMI hospitalizations.

Aim: To characterize the 2013-2014 epidemic season from the results of detection of influenza infection in patients; to provide the molecular genetic characteristics of the strains isolated from deceased patients., Subjects and Methods: The investigators examined 1203 patients (387 children, 509 people older than 16 years of age, 307 pregnant women) admitted to Moscow Clinical Infectious Diseases Hospital One with the clinical signs of acute respiratory viral diseases. Nasal lavage and autopsy specimens were used to isolate viral strains, then to sequence genomic fragments, and to determine receptor specificity., Results: Out of the 1203 examinees, 284 (23.6%) were influenza-positive: 221 (77.8%), 24 (8.5%), and 39 (13.7%) patients had influenza A(H3N2), influenza A(H1N1)pdm09, and influenza B, respectively. Influenza was notified in 42,7% of the pregnant women. There was a preponderance of its moderate form; its severe form developed in single cases having comorbidities. One fatal outcome was registered. The intake of antiviral medications in the first 48 hours of the disease could prevent complications. The investigators revealed mutations in the strain isolated from the bronchoalveolar lavage fluid of a patient with severe pneumonia complicated by acute respiratory distress syndrome., Conclusion: There is evidence that there are mutant A(H1N1)pdm09 viruses that have high pneumotropicity. The high risk of their circulation in the population and the risk of severe influenza forms involving the lower respiratory tract remain. Early antiviral therapy in the first 36-48 hours diminishes the clinical manifestations of influenza and reduces the risk of developing complications.

Aim: To study the clinical features of pertussis in adults., Subjects and Methods: The clinical manifestations of pertussis in adults were analyzed in 62 patients treated in the Core Unit and Obstetric Unit, Clinical Infectious Diseases Hospital One, Moscow Healthcare Department, in 2011-2013., Results: Investigations conducted in the familial foci of pertussis showed that its incidence rate was 23.7 and 10% in adults and in pediatric institutions, respectively. The source of infant infection was adults in almost one third of cases, mothers in 72% and fathers in 27.7%. Assessment of the symptom complex of pertussis in the sick mothers in the observed period ascertained that 94±3% had experienced the typical form of whooping cough: 72.0±5.7 and 22.0±5.3% had its mild and moderate forms, respectively. The disease had run a latent course in 6±3% of the patients. The paper describes cases of pertussis in 5 pregnant women admitted to the obstetric unit for complaints of persistent cough. The diagnosis of whooping cough in all the cases was based on clinical and epidemiological findings and serological tests showing specific IgA and IgG antibodies. Three and two patients experienced moderate and mild pertussis, respectively., Conclusion: Pertussis now remains one of the infectious diseases relevant not only to a pediatric population, but also to an adult one. Adult pertussis maintains the main clinical features typical for this infection with a predominance of its mild forms, which makes its diagnosis difficult. A serological test (enzyme immunoassay) is of high diagnostic value for verifying whooping cough in adults under the present conditions.

Aim: To evaluate albuminuria (AU) in the Moscow Region's dwellers visiting the health centers and to clarify its association with the proven and discussed risk factors (RF) of chronic kidney disease (CKD)., Subjects and Methods: A total of 1623 patients (390 (24%) men and 1233 (76%) women; mean age 46 +/- 16 years) were examined. Urinalysis using test strips was performed in all the examinees. AU was estimated by the following scale: normal AU (NAU) (< 10 mg/l), an initial increase (11-30 mg/l), a pronounced increase (31-300 mg/ml), very high AU (> 300 mg/ml). A questionnaire covering gender, age, patients' anthropometric data, comorbidities, healthy lifestyle adherence, and smoking was designed to assess possible RFs for CKD. Body mass index (BMI) was calculated. Medical history examination showed metabolic disturbances and cardiovascular diseases., Results: The detection rate of NAU was 18%; the initial and pronounced increases were found in 40 and 41% of the examinees, respectively; the very high AU was in 1%. The first questionnaire items associated with AU > 30 mg/ml were complaints of edema, sternal pain, poor appetite, meat aversion, and constant thirst. The detection rate of AU > 30 mg/l in hypertensive persons was 51%. If the patients had diabetes mellitus or a history of increased blood glucose episodes, the detection rate of AU > 30 mg/l amounted to as much as 65.5%. Estimation of overweight and obesity indicated that AU of > 30 mg/l was found in 44 and 49% of cases, respectively (p < 0.001). Analgesic abusers, long-term smokers, and sedentary people were statistically significantly more frequently found to have AU of > 30 mg/l., Conclusion: The pronounced and very high AU was noted in more than 40% of those who had visited the health centers. A questionnaire survey makes it possible to reveal a variety of AU increase-associated factors that primarily reflect metabolic disturbances and cardiovascular diseases and to identify a risk group in order to study AU first. Particular emphasis should be placed on the examinees' lifestyle. Healthy lifestyle non-adherence is closely correlated with increased AU and may be regarded as a RF for CKD.

Aim: To investigate the risk factors and main clinical signs of fatal pulmonary thromboembolism (PTE) in young subjects., Subjects and Methods: Medical case reports and postmortem examination results were retrospectively analyzed in 32 patients (all males) who had died from PTE in different Moscow health care facilities in 2002 to 2010., Results: No idiopathic thromboembolism cases were found. Each patient had at least two risk factors. Most patients developed generalized obstruction of the pulmonary vascular bed, by involving mainly the great arteries, which resulted in right ventricular failure and sudden death. CONCLUSION; The findings may be used not only to assess the clinical probability of PTE diagnosis, but also to choose adequate preventive measures.

The problem of invalid rehabilitation in Russia is an important state task and dictates necessity of design of an effective state program of primary prevention of cardiovascular diseases. Common global practice of medico-social model is based on complex detailed medico-social aid. Rehabilitation of postmyocardial infarction patients consists of three phases (stages): hospital posthospital (readaptation) and postreconvalescent (supportive). The program includes physical, psychological and pharmacological rehabilitation. Departments of readaptation and medico-social rehabilitation provide effective conduction of all kinds of rehabilitation. The Moscow North-East Regional Administration has a rich experience in organization of departments of readaptation and medico-social rehabilitation. The departments practice an individual approach to the patients and work in a close contact with bureaus of medico-social commission of experts. Management of patients by cardiologist, rehabilitation specialist and outpatient clinic's physicians provides uninterrupted staged rehabilitation, timely correction of pharmacotherapy, early patient referral to invasive investigations and treatment of coronary heart disease. A course of rehabilitative measures lasts 2 months. Setting up departments of medico-social rehabilitation in outpatient clinics provides more effective use of money assigned by the state for social support of invalids.

Aim: To estimate survival median and its changes, number of patients over 18 years of age for 1991-2000 and 2001-2010 for 20-year period (1991-2010), to elucidate factors affecting survival for 2001-2010 in mucoviscidosis children living in Moscow and Moscow Region and treated outpatiently in specialized medical centers., Material and Methods: Case records were analysed for mucoviscidosis patients registered in specialized clinics of Moscow on 01.01.01 and 01.01.11. Survival was assessed with Kaplan-Meier curve., Results: Survival medians for 1991-2000 and 2001-2010 was 25.7 and 35.1 years, respectively In the group of mucoviscidosis patients with Staphylococcus aureus infection survival was significantly higher than in those infected with gram-negative microflora. Longer survival was reported in patients with "soft" mutation (p = 0.06927)., Conclusion: The survival median for mucoviscidosis patients for 2001-2010 was 35.1 years. The percentage of adult patients in the last decade significantly rose from 19.5 to 32%. Gram-negative microflora significantly reduces survival, while 'soft" mutation prolongs survival. Creation of National Register will specify survival of mucoviscidosis patients in all regions of the Russian Federation.

Aim: To investigate frequency of carriage of genetic polymorphisms CYP2C9 and VKORC1 in patients with venous thromboembolic complications (VTEC) in Moscow population given warfarin treatment and effects of this carriage on stability of anticoagulation and frequency of hemorrhagic complications (HC) in warfarin treatment., Material and Methods: The study included 111 patients with the history of deep vein thrombosis and/ or pulmonary artery thromboembolism. All the patients received non-fractionated or low-molecular heparin for at least 5 days, then warfarin (target INR 2.0-3.0). Warfarin dose was selected empirically. Gene CYP2C9 and VKORC1 polymorphisms were studied. HC were endpoints., Results: Genotype CYP2C9*1/*1 (a "wild" type) was detected in 94 (84.7%) patients. Of other genotypes - heterozygotes CYP2C9*1/*2 (4.5%) and CYP2C9*1/*3 (10.8%). Genotyping by VKORC1 detected genotype GG (a wild type) in 42.3%, genotype GA--in 48.6%, genotype AA--in 9.1% patients. A mean warfarin dose, supporting an adequaite INR, was asspciated with both genotype CYP2C9 and VKORC1. Warfarin doses were highest in carriers of wile genotypes CYP2C9 and VKORC1 (6,9 and 8,8 mg/day), the lowest--in patients with genotypes CYP2C9*1/*3 and VKORC1 (4,5 and 4,0 mg/day). The carriers of polymorphisms CYP2C9*1/*3 and VKORC1 showed less stable anticoagulation vs carriers of allele variants CYP2C9*1/*1, CYP2C9*1/*2 and genotypes GG, GA VKORC1. An HC rate depended, as a rule, on carriage of genotypes CYP2C9*1/*3 and AA VKORC1. The highest risk of HC was associated with genotype CYP2C9*1/*3. The results of multifactorial regression analysis also indicated that carriage of genotype CYP2C9*1/*3, a female gender and the range of INR in warfarin treatment > or = 2,66 are independent predictors of HC in VTEC patients on warfarin treatment., Conclusion: Carriage of gene CYP2C9 and VKORC1 polymorphisms affects suppoting dose of warfarin and rate of hemorrhage in patients with VTEC in Moscow population. Frequency of HC is the highest in carriers of genotypes CYP2C9*1/*3 and AA VKORC1, they need minimal supporting dose of warfarin. Carriage of genotype CYP2C9*1/*3 in line with a female gender and instability of INR is an independent predictor of HC in VTEC patients in Moscow population on warfarin treatment.

Aim: To obtain objective information on the quality of pulmonological outpatient care for patients living in the North Administrative District (NAD) of Moscow; to propose methods of this care improvement., Material and Methods: An epidemiological study of Moscow NAD population was made to detect respiratory diseases, to assess qualification of district physicians in management of most prevalent chronic diseases of the respiratory system: bronchial asthma (BA) and chronic obstructive pulmonary disease (COPD)., Results: The epidemiological study has revealed standard errors of district physicians in management of BA and COPD patients. Effective measures on reduction of the typical mistakes are proposed., Conclusion: More active detection of respiratory diseases in Moscow population is recommended.

Aim: To determine borderline values of intima-media thickness (IMT) of the common carotid arteries (CCA) in Moscow citizens without clinical symptoms of atherosclerosis., Material and Methods: A total of 885 (277 males and 608 females) Moscow citizens aged 20-79 years free of clinical symptoms of atherosclerosis participated in population-based epidemiological trial. CCA IMT was measured at ultrasonic scanning of the carotid arteries in high-resolution regimen., Results: The trial provided data on variability of CCA IMT borderline values in different age groups of adult Moscow metaethnic population without clinical symptoms of atherosclerosis with gender reference. Quartile distribution of CCA IMT values enabled primary evaluation of predisposition of the population studied to atherosclerosis., Conclusion: This pilot study is the first to give Russian data on variability of population borderline values of CCA IMT obtained in the study of a representative sample. Russian data give additional material to European geographic gradiet CCA IMT and allow more accurate ultrasonographic identification of predisposition to atherosclerosis in persons with silent disease.

Aim: to study the prevalence of various risk factors (RF) for venous thromboembolic events (VTEE) and their association with D-dimer levels., Subjects and Methods: The clinical, demographic, anthropometric, anamnestic, and laboratory data were analyzed in 106 patients (73 men and 33 women) aged 18 to 78 years admitted to hospital with the first or recurrent episode of VTEE., Results: RF and VTEE-associated diseases were identified in all patients. Over 90% of the patients had more 2 RFs. The most common RFs were the age above 40 years (85%) and overweight (82%), including obesity (42%). There was a preponderance of cardiovascular diseases in the pattern of VTEE-associated diseases. The direct causes (precipitating factors) of thrombosis were revealed in 57% of cases; the thrombotic episode was classified as idiopathic in 43%. Elevated D-dimer levels were found in 74% of the patients. Higher D-dimer content was seen in women, non-smokers, patients operated on for thrombosis, those who had 2 precipitating factors or more, and those who had a less than 30-day history of thrombosis. There was an inverse correlation between the elevated level of D-dimer and the duration of thrombosis by the moment of its identification (thrombus age)., Conclusion: All patients who have experienced a venous thrombotic episode have various RFs for VTEE The content of D-dimer exceeds the normal value in most patients with VTEE. Among the RFs studied, thrombus age is the most important factor associated with elevated D-dimer levels in patients with VTEE

Aim: To characterize prevalence and features of low back pain (LBP) in Moscow outpatients., Material and Methods: The questionnaire designed in the Rheumatology Institute of Russian Medical Academy was used in the trial performed for a month with participation of 1300 Moscow outpatients aged 18 to 50 years., Results: LBP is a frequent cause of consulting a physician in an outpatient practice. Most of the outpatients complained of acute and subacute moderate or severe LBP. This pain often caused disability. Of diagnostic tools most frequent was x-ray investigation of the spine., Conclusion: Spinal osteochondrosis is the most frequent diagnosis made in LBP outpatients. Detectability of threat marks in LBP patients is not more than 10%.

Aim: To study prevalence of the principal symptoms of gastroesophageal reflux disease (GERD) in Moscow., Material and Methods: A total of 1065 respondents aged 15-85 years (a random representative sample of population of one of the typical Moscow districts) participated in a questionnaire survey using the international questionnaire for detection of GERD incidence., Results: Epigastric burning (EB) occurs in 39.6% examinees. GERD prevalence is 14.2%. Subjects with EB have the following symptoms of GERD: regurgitation (66.3%), epigastric pain (discomfort) (53.0%), nausea (43.6%), vomiting (23.2%), dysphagia (20.6%), chest pain (18.0%), odinophagia (5.5%), singultus (4.6%). There is a direct correlation between incidence rate of EB, height, body mass index, number of alcohol excesses and smoked cigarettes., Conclusion: EB occurs in both young and aged men and women with similar frequency. Significant differences were detected only in the age group 45-59 years in which EB is more frequent in women. All the symptoms excluding cough and singultus were seen in women significantly more frequently. With age, these differences disappeared but noncardial pain in the chest that was less frequent in the elderly. Muscovites with GERD symptoms are older (61.26 +/- 13.47 years) than those without such symptoms (58.44 +/- 16.28, p < 0.0001).

Aim: To estimate potentialities of early diagnosis of rheumatoid arthritis (RA) diagnosis in clinical practice in the course of the RADICAL program., Material and Methods: Of 366 patients participating in the trial 61 (16.7%) were males and 305 (83.3%) were females at the age of 47.76 +/- 14.1 years. The longest duration of the symptoms before consulting a doctor was 51 weeks, mean duration--5.7 weeks, 55% patients had the symptoms for 3 weeks. All the patients have undergone laboratory examination including leukocyte count, platelet count, estimation of ESR, concentration of C-reactive protein (CRP), rheumatoid factor (RF) and antibodies to a cyclic citrullated peptide (ACCP); roentgenography of the wrists and feet. On demand, antinuclear factor (ANF) and HLA-B27 were investigated. RA was diagnosed on the basis of ACR classification criteria. If the criteria were not complete at the moment of the study, the patient was referred to the group of "undifferentiated arthritis" (UA). The patients were examined before the treatment, 6 and 12 months later. The treatment was made according to Russian clinical recommendations., Results: Prior to admission to hospital, 58% patients were suspected for RA, 18.3%--osteoarthrosis (OA), 14%--reactive arthritis. 18.9% were not diagnosed, other diagnoses were considered in 12.6% patients. At primary examination RA was diagnosed in 212 (57.9%) patients, UA was in 133 (36.3%) patients, 21 (5.7%) patients had other diagnoses. Twelve months later RA, UA and other diseases were diagnosed in 256 (69.9%), 70 (19.1%) and 40 (10.9%) patients, respectively., Conclusion: A 3-stage algorithm of early RA diagnosis is proposed. At the stage of the first contact with the patient in an outpatient clinic a valid RA suspition with consideration of modified EULAR criteria must be formulated. At the second stage a district rheumatologist must examine the patient outpatiently with determination of ACR classification criteria. In diagnosis verification the treatment must be started according to APP and EULAR clinical recommendations. If RA diagnosis can not be verified or rejected, the patient must be refered to hospital (stage 3). If verification of RA diagnosis is impossible, the diagnosis should be formulated as UA.

Aim: To study present-day clinical manifestations of scarlatina., Material and Methods: The authors have reviewed 138 case histories of children with scarlatina treated outpatiently and 51 case histories of hospitalized scarlatina children as well as social and age characteristics of 1657 children and 108 adults hospitalized in the infectious hospital N 1 in 1962-2001. Official data on scarlatina morbidity in Moscow and Russia for 1991-2001 are presented. Antibiotic sensitivity of 414 cultures of group A streptococci (GAS) isolated in 1987-1995 and 1996-2001 was investigated., Results: Overall and seasonal scarlatina morbidities in 7-14-year-olds appeared to rise significantly. In the majority of cases scarlatina took a mild course but in the adults clinical picture of the disease was rather severe. GAS demonstrated high sensitivity (about 100%) to betalactamic antibiotics. The percentage of erythromycin-resistant streptococcal cultures increased more than 9-fold and reached 1.9% (1996-2001). There is a marked trend to a proportional increase of GAS cultures resistant to tetracycline and gentamycin., Conclusion: Recently, changes have occurred in scarlatina epidemiological and clinical features. Different sensitivity of GAS to antibiotics must be taken into consideration for prescription of etiotropic treatment and prevention of scarlatina at jobs.

Aim: To characterize hypertensive patients, residents of Moscow, treated at Moscow Municipal Cardiological Center (MMCC) in 1999., Material and Methods: A total of 1056 case histories of patients with the diagnosis of arterial hypertension or essential hypertension, directed to MMCC in 1999, were analyzed. The files were processed using specially developed standard methods., Results: Patients with stage III essential hypertension aged over 60 years are most often treated at MMCC. Patients with more severe left-ventricular hypertrophy more often have cardiovascular complications., Conclusion: High incidence of cardiovascular complications indicates that the treatment of patients in an outpatient setting is poor.

Aim: To elucidate joint hypermotility (JHM) among adult population of Moscow by age and sex., Material and Methods: Health survey covered 572 examinees (266 females and 306 males) in four age groups (16-20, 21-30, 31-40 and 41-50 years). JHM was assessed by Baton's scale., Results: Prevalence of JHM in Moscow was similar to that in Europe. JHM occurred more frequently at young age and in women. The score 4-6 by Baton in Russian population (50% of 16-30-year-old women and 58% of 16-20-year-old males) is a variant of normal standard.

Aim: To analyse epidemiologically chronic heart failure (CHF) according to 1996 records for patients admitted to therapeutic and cardiological departments of Moscow city hospital N 64., Materials and Methods: An individual sheet has been developed for computer. The statistical processing has been conducted according to Access 97 program. It has covered 4019 case histories for 1996. 1232 patients were hospitalized for chronic cardiac failure this making 30.6% of all the hospitalizations., Results: CHF was encounted in 60.9% of females and 39.1% of males. It was due to: ischemic heart disease (63.7%, with myocardial infarction in 73%), hypertension (17.5%), valvular disease (13.7%), dilated cardiomyopathy (3.7%), myocarditides and perocarditis (1.4%). Age groups 30-39 years, 40-49, 50-59, 60-69, 70-79, 80-89, 90-99 consisted of 0.6, 4, 11, 35.2, 31.4, 16.9, 0.6% of patients respectively. Females prevailed in the oldest age groups. The time from CHF diagnosis was 2, 3, 4, 5, 6, 7, 8, 9 and > 10 years in 26, 10.9, 4, 5.7, 0.9, 1.4, 1.7, 0.6 and 4% of patients, respectively. 72.9% of patients were admitted to hospital once a year. 19.7%, 5.2%, 0.9%, 0.6%, 0.9% of patients were hospitalized 2, 3, 4, 5 and more than 6 times, respectively. CHF was responsible for 50(27.8%) lethal outcomes of 180. Lethality resulted from cardiovascular insufficiency (50%), thromboembolism (30%), pneumonia (10%)., Conclusion: CHF is a frequent cause of hospitalizations. Development of CHF, lethality, age groups distribution are closely associated with the patients' gender.

Aim: To elucidate significance of early diagnosis and results of surgical treatment of valvular defects in active infectious endocarditis (AIE)., Materials and Methods: Surgical outcomes were analyzed for 437 AIE patients with active AIE. The operation was made 10 months, on the average, after AIE onset., Results: Total hospital lethality made up 11.2%. Total 5-year survival with account for hospital death was 77-80% in replacement of one valve and 61.6% in replacement of two valves (mitral and aortic). In natural course of the disease it was 16%., Conclusion: There was a direct relationship between hospital lethality and admission condition of the patients, advance of the inflammation. This urges early AIE detection and performance of operation before development of irreversible changes in the myocardium and other organs.

Aim: Assessment of the probability of decreasing cardiovascular mortality by detecting and treating coronary patients and patients with arterial hypertension and correcting the risk factors., Materials and Methods: A prospective ten-year registration of the mortality of the male population aged 40 to 59 years was carried out at a Moscow territory with two health centers. The subjects were routinely screened for coronary disease, arterial hypertension, hypercholesterolemia, excess body weight, tobacco smoking, insufficient exercise. During the first five years of the follow-up they were involved in treatment and prophylaxis measures varying in activity and direction (the two health centers were specialized in prevention and common treatment)., Conclusion: Multifactorial prophylactic intervention helped delay untimely death in all the population examined, mainly due to detection of cardiovascular diseases. The life prognosis was improved most appreciably in the cases when the levels of risk factors were decreased due to multifactorial prevention in comparison with the life prognosis for subjects with a similar decrease of risk factors but without prophylactic intervention.

Aim: To determine occurrence of cryoglobulinemia (CGE) in residents of Moscow with various rheumatic diseases and healthy subjects, in Tynda population (migrants to Siberia) with rheumatic arthritis (RA) and healthy ones., Materials and Methods: CG screening was performed according to the WHO recommendations among 243 rheumatic patients from Moscow, 500 healthy subjects living in Moscow, 72 RA patients from Siberia and 1750 healthy Siberia migrants., Results: CGE occurred more frequently among Moscovites with SLE and RA (28 and 19%, respectively). In RA Siberians CGE was present in 52%. In healthy Siberians CGE occurred in 8.4% of the examinees, in Moscovites it was extremely rare. In all the examinees CGE was associated with cryoglobulinemia syndrome. SLE and RA Moscovites had mixed CGE with monoclonal components (type II), RA Siberial migrants had CGE type II and III (mixed polyclonal)., Conclusion: The study of CGE incidence in healthy migrants to Siberia with different duration of residence, measurements of metal ions in RA Siberians with and without CGE in the serum, blood cells and cryoprecipitates provided the authors with information for a new hypothesis of CGE origin and design of new policy of treating CGE.

The trends in prevalence of ischemic heart disease (IHD) and risk factors for 1985-1995 have been studied on random representative samples of male population from Moscow. For the decade studied IHD incidence increased, especially in younger males. Changes in IHD risk factors were the following: systolic and diastolic pressures were on the increase. HDLP cholesterol and total cholesterol in the blood lowered, total triglycerides were unchanged, incidence of smoking remained high.

Sample examination of the population aged 25-64 basing on the disease history, fasting blood glucose test, glucose tolerance test, WHO criteria, diabetes mellitus was found in 6% of males and 6.9% of females. Only 2.7% of males and 3.1% of females were aware of their disease. Glucose tolerance test discovered abnormal carbohydrate tolerance in 5.6% and 13.3% of male and female examinees, respectively. Thus, a total of 12.2% of males and 20.2% of females had various disorders of carbohydrate metabolism. Diabetes mellitus patients had often hypercholesterolemia, hypertriglyceridemia, obesity, hypertension, low 10-year survival.

The examination covered 125 elderly and senile subjects (106 females and 19 males) which made up 90.6% of those living in the boarding house. Their mean age was 81.3 years. Arterial hypertension was detected in 61.6% of the examinees. 18.5% of the examinees had hyperuricemia. Concentration function of the kidneys was affected in all the examinees. Half of them exhibited a moderate rise in the level of blood creatinine. The authors discuss the relationship between high prevalence of arterial hypertension, its tendency to crises and involutional processes in the kidneys in the onset and development of renoprival condition.

Clinicohematological investigations and cytogenetic analysis of blood lymphocytes were made 5-7 years after the Chernobyl accident in 201 liquidators who had worked in the radionuclide-contaminated zone. Among the somatic diseases found in the examinees statistically more prevalent were cardiovascular and gastrointestinal affections, asthenic syndrome, thyroid disorders. Hemograms presented a rise in hemoglobin, red cell and eosinophil content, a drop in the number of neutrophils. A tendency to erythrocytosis was observed in 20.3% of the wreckers. Dicenters and rings were abundant in the lymphocytes of 69% of the cytogenetically examined examinees 5-7 years after the exposure to radiation.

Diphtheria morbidity among adult population of Moscow is growing. The tests of different modes and schemes of heterogeneous antidiphtheria serum administration have found out that the highest efficacy of serotherapy was achieved with a single intravenous dose. Another treatment of diphtheria is hemosorption. Widely used in present-day clinical practice hemosorbents provide adequate elimination of the toxin from plasma. The authors analyse the present situation in clinical symptoms, complications, lethality of diphtheria basing on the data provided by S. P. Botkin's Hospital.

The paper presents the results of clinical and laboratory examination made in 3 groups of children: populational, hospital and control (a total of 176 patients). The children were diagnosed to have variants of dysmetabolic nephropathy (DN) which had become a problem not only for urolithiasis-endemic regions, but also for the Middle Russia. The study involving characterization of cytomembranes, renal tissue biopsy allowed conclusion on nonspecific DN symptoms. Obligatory symptoms were those of OCC, microhematuria and/or mild proteinuria, changes in cytomembranes, weak tubular function, tubulo-interstitial changes. DN genesis is thought multifactorial, involving genetic predisposition, biochemical defects, ecological hazards.

A representative population sample was studied to elucidate relationships of arterial pressure (AR) with muscular performance (MP) and arterial hypertension risk factors. Power working capacity (PWCx) was measured by means of exercise tolerance test at rest, under physical loading and after the exercise. The findings were processed using a multivariate step-by-step regression analysis which established independent relations between exercise and postexercise MP and arterial hypertension. In normal and hypertensive males a rise in systolic pressure (SP) after the initial exercise (load 1) was dependent on PWC1 after more intensive exercise (load 2) on relations of MP with heart rate, SP and diastolic pressure (DP). In hypertensive males the SP elevation depended also on the age, B. W. index and heart rate. In normal AP males a DP rise depended on PWC2 and MP, the increment being limited by relationships between MP, DP, heart rate and SP. In hypertensive males the influence of PWC1 is defined through a SP rise after load 1. In normal AP and hypertensive females PWC1 is decisive for a SP rise. In normal AP females growth of DP after load 2 was dependent on PWC2 in relation to heart rate growth after load 2, while in hypertensive females PWC1 resulted in DP elevation after load 1. On comparison of the groups with normal and high AP the degree of AP increment under exercise depended on the relations of MP with heart rate, SP and DP.

The authors observed 32448 cases of alimentary toxoinfection (AT), 96.8% of which were females. Acute surgical abdominal conditions arose in 3.6% of them: appendicitis, cholecystitis, pancreatitis. Aggravation of chronic diseases occurred in 11.6% of the patients, hypertension and cholelithiasis being most frequent. 119 patients developed myocardial infarction, 266 hypertension crisis. The occurrence of acute and chronic diseases were analyzed in relation to common pathogenetic features, role of infection, intoxication, microcirculatory disturbances and hemostatic impairment. AT are suggested as risk factors of certain diseases likely to deteriorate prognosis.

A number of epidemiological surveys have recently established that in populations with the lowest levels of total cholesterol (TC) and LDL cholesterol (LDLC) death rates grow due to both malignant and cardiovascular diseases. The results of a detailed study on multifactor prevention of coronary heart disease (CHD) in an open population of Moscow males aged 40-59 to elucidate the relations between TC, HDL cholesterol, LDLC and CHD mortality demonstrated that low levels of TC are markers, but not a factor of CHD and sudden death risk in low-educated subjects free of CHD symptoms. When planning mass measures to primarily prevent CHD, subjects with low cholesterol levels should be given a special care as well as those with hypercholesterolemia.

The incidence rate of HLA class I and II antigens has been studied in 168 and 82 patients with diffuse toxic goiter, respectively. Positive association is found for HLA antigens A2, A3, A28, B8, B15, B17, Cw4, DR5; negative one with antigens A24, Bw4, Bw6, Cw1, Cw2, Cw3, Cw5, DR9. Prevalence of antigens B15, B17, Cw4, DR5 is associated with thyrotoxicosis severity, A2 with recurrent toxic goiter. Antigen B8 plays the role of an immunogenetic marker of endocrine ophthalmopathy.

Long-term results of electroimpulse treatment for cardiac fibrillation in 1292 patients performed in cardiological clinics of Moscow and Kaunas have been compared. It is shown that more strict selection, longer preparation for the impulse exposure may secure a significant decrease in the number of the fibrillation recurrences both 1 and 6 months after recovery of the normal rhythm.

The prognostic significance of some behavioral habits was examined in an open male population aged 40 to 59 years in respect to mortality. The analysis has demonstrated that tobacco-smoking leads to an increase in the total mortality rate and in mortality from cardiovascular and cancer diseases. The total mortality in the population was on the whole 1.5 times higher as a result of frequent alcohol use, mainly at the expense of the mortality growth because of other reasons (traumas, accidents). The work characteristics being the same, the total mortality from cardiovascular diseases and other reasons appeared significantly less in persons who were physically active in their leisure time as compared to those who were inactive. The analysis has also shown that studies into behavioral habits made by questionnaires in patients suffering from coronary heart disease should be performed in combination with other measures. At the same time the use of the questionnaire allowing the assessment of physical activity is advisable only in persons without coronary heart disease.

Postal questionnaires were used to study the incidence and intensity of complaints of the spine and peripheral skeleton in patients with ankylosing hyperostosis of the spine. Selection of persons to fill in questionnaires was carried out by means of a preliminary non-randomized analysis of the records of the spinal fluorograms in patients of one of the outpatient clinics of Moscow. Criteria for ankylosing hyperostosis of the spine were the presence of continuous ossification of the anterior longitudinal ligament over a length of not less than 4 successive segments of the spine and the lack of other x-ray alterations in the given part of the spine. It has been established that as compared to the control group (n = 41) without any x-ray alteration in the thoracic part of the spine, the patients with ankylosing hyperostosis of the spine (n = 146) complained of the lumber part and shoulder joints more frequently. The incidence of complaints of other 6 out of 8 parts of the skeleton under analysis was not high in ankylosing hyperostosis of the spine.