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Aim: Retrospective analysis of the underlying causes for death of patients who did and did not seek outpatient medical care (OPMC) for ischemic heart disease (IHD), and discussion of a possibility for using administrative anonymized but individualized databases for analysis., Material and Methods: The electronic database of the Central Administration of the Civil Registry Office of the Moscow Region (Unified State Register of the Civil Registry Office of the Moscow Region), including medical death certificates (MDC) for 2021, was used to select all cases of fatal outcomes with the disease codes of the International Classification of Diseases, Tenth Revision (ICD-10) (codes of external causes, injuries, poisonings excluded) that were indicated as the primary cause of death (PCD). Personalized data of the deceased were combined with data from electronic medical records of patients who sought OPMC at institutions of the Moscow Region within up to 2 years before death. In addition to IHD, the following PCD codes were taken into account: malignant tumors, COVID-19, diabetes mellitus, cerebrovascular diseases, hypertension, chronic obstructive pulmonary disease, alcohol-associated diseases, and, as examples of unspecified PCD, old age and unspecified encephalopathy.Results In total, among those who died from diseases, the proportion of those who died from IHD was 18.9%; for another 8.4%, IHD was indicated as a comorbid disease in Part II of the MDC. Among those who sought OPMC for IHD, the IHD proportion indicated as PCD was 27.5%, and among those who did not seek OPMC 17.4% (p <0.0001). Those who died from IHD and who had sought OPMC were older (mean age, 75.59 ± 10.94 years) than those who died from IHD and had not sought OMPM (mean age, 73.96 ± 10.94 years; p < 0.0001). The frequency of myocardial infarction as PCD among those who had and had not sought OPMC was the same (12%), chronic forms of IHD were 83.9% and 79.7%, the frequencies of "unspecified" acute forms of IHD (codes I24.8-9) were 4.1% and 8.3%, respectively. The proportion of deaths from COVID-19 was the highest (21.7% and 24.3%, respectively), from malignant neoplasms 11.6% and 12.7%, respectively, and from unspecified encephalopathy 10.6% and 10.7%, respectively., Conclusion: Only 25% of patients who had sought OPMC for IHD died from IHD, otherwise the causes of death were the same as for patients who had not sought OPMC for IHD. Analysis of administrative databases allows identifying disparities in the PCD structure and to direct the efforts of specialists to reconciling the criteria for death from various forms of IHD.

The mortality is a major component of damage caused by COVID-19. The comparative analysis of changes in mortality was carried out on the basis of the ROSSTAT data over 2012-2020 to determine differences in losses of male and female population caused by pandemic in Moscow. It is demonstrated that at close trends in mortality of males and females before pandemic, in 2020 their mortality changed differently. At equal increase of male and female mortality, main contribution into excess mortality (excluding contribution of COVID-19) was made approximately equally by diseases of nervous system and circulatory system in males and diseases of nervous system in females. The male mortality from COVID-19 is 1.9 times higher than female mortality. As a result of younger average age of death the amount of economic losses in terms of years of potential life lost (PYLL) due to premature death of males because of COVID-19 exceeds economic losses due to premature death of females up to 2 times. Although the average age of death of females from all causes decreased by smaller amount, their values of PYLL increased more, mainly due to higher rate of female mortality from disease of nervous system and from mortality related to drug addiction. In Moscow, the highest increase of PYLL is conditioned by dearth related to drug addiction and alcohol consumption. In the structure of this indicator in males they are ranked fourth and fifth. In females, alcohol-related deaths are ranked as sixth and drug-related deaths as eighth. The pandemic, contributing into increase in economic losses, didn't change their leading causes: diseases of circulatory system, external causes and neoplasms in males; neoplasms, diseases of circulatory system and external causes in females. The value of PYLL due to death from COVID-19 takes sixth place in males and fourth place in females.

Objective: To create a new taxonomy of schizophrenia spectrum disorders (SSD) based on the comparability of the design of SSD and borderline states., Material and Methods: The total sample consists of 205 patients with an established diagnosis of SSD (F21; F25; F22 according to ICD-10) collected from studies of the department of borderline mental pathology and psychosomatic disorders of the Federal State Budgetary Institution Mental Health Research Center and the Department of Psychiatry and Psychosomatics of Moscow State Medical University in the period 2014 to 2024. Clinical, psychometric, statistical methods were used., Results: A new two-level model of schizotypal personality disorder (STPD) has been developed: the first level is psychopathic-like disorders of the «Ferschroben» type; the second level are psychopathological disorders (positive, negative, etc.), appearing under their «mask», constituting a «tracing paper» of manifestations of schizophrenia «in miniature». The two-level psychopathological model of STPD is a complex clinical phenotype, including independent but overlapping phenotypic formations: psychopathic-like - the «Ferschroben» type; and basic - schizophreniform disorders., Conclusion: The clinical classification of schizophrenia spectrum disorders has been developed; pseudoneuroses and stress-induced disorders of the endogenous circle are considered in the aspect of the dynamics of STPD.

Climate change and formation of regional weather features increase both direct (immediate effects of extremal temperature and other weather and climatic anomalies) and indirect (environmental deterioration, etc.) consequences of global climate change. The development of investigations of medical weather assessment, medical and meteorological forecasting system, the use of treatment and preventive measures give the opportunity to prepare for weather biotropic conditions and reduce weather-conditioned exacerbations., Objective: To assess the clinical effectiveness of non-drug comprehensive methods, including balneotherapy and physiotherapy, in patients with somatic diseases, complicated by increased meteosensitivity, depending on the features of weather conditions in the Moscow region., Material and Methods: The study included 120 patients diagnosed with «osteoarthrosis/osteoarthritis» with predominant hip and knee joint damage. The majority of patients had comorbidities, namely hypertensive disease (67.2%), ischemic heart disease (32.8%), chronic obstructive pulmonary disease and bronchial asthma (10.8%), grade II-III obesity (10%) and compensated diabetes mellitus (9.2%). The severity and main symptoms of the meteopathic reactions' manifestation were assessed by questionnaires consisting of three blocks, HAM, SF-36 tests and psychological stress scale. Medical and meteorological assessment of weather conditions in Moscow included analysis of the main weather-forming factors for 4 main synoptic observations in 10-minute mode for current and predictive 2 days, as well as daily characteristics of solar activity. Treatment methods included alternating magnetic field (AMF) procedures, general sodium chloride baths, massage and rehabilitation exercises (RE) (1st group); AMF, «dry» carbon dioxide baths, applications with brine on the affected joints and RE (2nd group); AMF, «dry» radon baths, applications with brine and RE (3rd group)., Results: The conducted studies have revealed the trigger role of most biotropic combinations of weather-forming factors that provoke exacerbation in patients with joint diseases. Sodium chloride, «dry» carbon dioxide and radon baths combined with AMF, applications with brine on the affected joints and RE are pathogenetically justified and contribute to increase of adaptive potential, functional reserves of the body and provide significantly high ( p< 0.05) meteocorrective action., Conclusion: The obtained results can be used for rehabilitation of patients with joint diseases complicated by increased meteosensitivity.

Objective: To evaluate the effect of discontinuation or prolongation of DMT on the activity of the disease during pregnancy and in the postpartum period in patients with aggressive MS from the Moscow region., Material and Methods: The study included female patients with an aggressive course of MS receiving DMT at the time of pregnancy. The patients were followed-up for the period 2016 to February 2024., Results: There were 17 cases of pregnancy during natalizumab (NZ) therapy; discontinuation of therapy in the first trimester of pregnancy provoked a resumption of disease activity in half of the patients. There were no exacerbations in patients whose therapy was prolonged until the 34th week of pregnancy. In 5 patients receiving fingolimod (FGL), therapy was discontinued upon the establishment of pregnancy, which caused the resumption of disease activity in three out of 5 cases. In 3 patients receiving anti-B-cell therapy, pregnancy occurred within a few months after the next infusion, there were no exacerbations during pregnancy., Conclusion: The cancellation of NS therapy in the early stages of pregnancy in most cases leads to the resumption of disease activity during pregnancy. Exacerbations in the postpartum period also correlated with early discontinuation of therapy and with a long period before the restart of infusions. Prolongation of infusions to 30-34 weeks of pregnancy contributed to stabilization of the condition throughout the perinatal period. Discontinuation of FGL therapy at the onset of pregnancy increased the risk of repeated relapses of the disease, up to the development of inflammatory immune restoration syndrome during pregnancy and contributed to the increase in disability in the postpartum period.

Objective: To analyze the contribution of alcohol and drug intoxication to fatal occupational injuries and sudden death at the workplace in Moscow., Material and Methods: A number of death cases of various organizations' employees equal 357 in Moscow in 2023 were investigated. The mean age of the deceased was 48.29±13.9 years, 92.4% of them were men., Results: Ethanol in blood has been determined in 15% of the deceased. Narcotic drugs and psychotropic medications have been found in 6.7% of cases. Signs of chronic intoxication have been established in 16.5% of the deceased. Chronic intoxication accompanied or aggravated the course of 70% of cardiomyopathies. The proportion of deceased in an accident at an industry or construction site equal 23.9%, as well as 1 / 2 of the deceased in an accident on the street and in a residential building were impaired by alcohol., Conclusion: The study of the contribution of alcohol and drug consumption to occupational mortality will allow to plan measures for reducing the mortality of working-age population.

Objective: To identify the association between cerebrovascular diseases (CVD) and multiple sclerosis (MS) among patients over 50 years old in two independent populations of Moscow and Tyumen., Material and Methods: The study included 94 patients with MS in combination with CVD (main group) and 90 age-and sex-matched patients with MS without a vascular history (comparison group). An analysis of parameters such as disease duration, EDSS at different time points, disease progression index, duration of first remission in each population separately and in both populations together was carried out., Results: The presence of CVD in patients with MS was associated with the presence of other diseases that are associated with an increased risk of developing cerebrovascular pathology. In the main group, there was a statistically significant decrease in the duration of the first remission and an increase in the disease progression index. In addition, other diseases and syndromes were identified in the main group that, in combination with CVD in patients with MS, could lead to a worsening of the course of MS. These included arterial hypertension, diabetes mellitus, obesity, dyslipidemia, chronic venous insufficiency, and regular use of proton pump inhibitors., Conclusion: Comorbid vascular pathology can affect the severity of MS from the very beginning of the disease. It can lead to a shorter duration of the first remission and a higher disease progression index, increasing the degree of disability. The combination of autoimmune-inflammatory, demyelinating, and vascular processes can worsen the prognosis for MS.

Dementia is one of the main challenges to modern society. According to estimated data, as of 2019, there were 1.949.811 people living In Russia with dementia of various etiology. At the same time, there have been no large epidemiological studies of dementia in the Russian Federation. The article provides an overview of the available data on the epidemiology of cognitive impairment (CI) In Russia given from various sources. Not only estimated, but also available clinical data were analyzed. In general, the obtained prevalence values for CI are comparable to global values. Thus, in an epidemiological study of people over 60 years of age in a separate district of Moscow, the prevalence of dementia was 10.4%, Alzheimer's disease 4.5%. A study of outpatients aged 60 years and older showed a high prevalence of both dementia and non-dementia CI at general medical appointments (incidence of dementia 7.8%, MCI 49.6%). It has been shown that the problem of non-dementia CI is already relevant in people of pre-retirement age (the prevalence of non-dementia CI in patients 55-64 years old is 36.8-44.8%). Unique data obtained in a population of institutionalized centenarians (prevalence of dementia 69%), as well as data on the relationship of CI with both somatic and demographic factors are presented.

Objective: To evaluate the incidence of laryngeal papillomatosis (LP) and LP recurrence in adults and to determine the risk factors for the development of LP recurrence in adults in Moscow. To solve the tasks set, a survey of patients carried out, including the collection of complaints and anamnesis, a standard examination of the ENT organs, an assessment of the condition of the larynx, and a histological examination., Material and Methods: We conducted a retrospective analysis of the case histories of 299 patients with LP observed and treated at the Sverzhevsky Research and Clinical Institute of Otorhinolaryngology in the period 2010-2020., Results: On average, over the entire study period, the prevalence of PG was 17.80%. It was found that out of 299 patients, 69.6% ( n =208) had a relapse of LP. Papilloma of the larynx were more often localized in the glottis. 275 (92%) patients had a widespread form of LP. LP recurrences were significantly more common in women and in patients with an existing cicatricle process in the larynx. The relapse rate was higher in non-smokers (73.5% vs 47.8%; p <0.001). Although the recurrence rate was higher in patients with non-voice occupations (70.6% vs. 52.9%), there was no statistically significant association between relapses and the vocal professions ( p =0.125)., Conclusion: As a result of the study, a number of risk factors for laryngeal papillomatosis recurrent have been identified, and their study should be continued.

Background: Despite implemented measures and general favourable trend, number of patients with myocardial infarction remains high, younger people are increasingly becoming ill and dying. The study purpose: to estimate age-sex mortality dynamics from acute and recurrent myocardial infarction in adults in Moscow compared to Russia's average in 2007-2021 to reveal patterns of mortality change within the implementation period of state prevention programs., Material and Methods: Standardized adult mortality rates for Moscow and Russia, mean expected age at death within interval 20-85 years and gain in life expectancy when eliminating this cause calculated and analyzed., Results: Moscow morbidity rates for acute and recurrent myocardial infarction are twice lower than Russia's, there are higher reduction rates for both diseases - by 16% and 58% respectively. During study period, mortality from myocardial infarction in men was by 45% higher than in women. In 2007 Moscow male-female difference estimated 3% and in 15 years it became 32% due to faster female mortality reduction. Whereas Russia's average age of death from myocardial infarction in 2021 returned to 2010-2011 levels, then in Moscow during 2020-2021 female rates returned to 2008's and male rates fall out the study period., Conclusions: Since implementation of the first programs on reducing mortality from chronic non-infectious diseases during the 15 years period morbidity and mortality rates from myocardial infarction reduced in Russia and Moscow in all ages. Acute and recurrent myocardial infarction have rejuvenated both in men and women as a negative effect of the pandemic.

Purpose of the Study: to determine the main threats to the health of the population of Moscow based on the analysis of the medical and demographic situation in Moscow and the Russian Federation in the context of the COVID-19 pandemic, in order to develop management decisions at the regional level., Material and Methods: Materials of the Federal State Statistics Service (Rosstat), as well as statistical collections of the Russian Research Institute of Health of the Ministry of Health of Russia for 2013-2022 were used., Results: Coronavirus infection has changed the morbidity and mortality rates of the population of the Russian Federation and its constituent entities. In the Russian Federation mortality in 2019-2021 increased from 12.3 to 13.6‰, while in Moscow the increase in the indicator is significant - from 9.5 to 16.7‰. The incidence of COVID-19 in Moscow in 2020-2021 (over the two COVID years) increased from 6191.0 to 8976.0‰oo. The noted decrease in incidence rates across almost all classes of diseases during the COVID period (2019-2020) was associated with the lower medical check-ups and preventive activities, while during 2019-2021 there was an increase in disease incidence of the following classes: mental disorders, behavior disorders; diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism, etc., indicating the need for rehabilitation of this group of patients., Conclusions: The need to counter the threats to the health of the population of Moscow caused by the coronavirus infection requires the development of management decisions aimed at strengthening preventive activities and rehabilitation of patients in the post-COVID period.

Introduction: Pestiviruses and viruses of the Herpesviridae family are widely distributed among different species of ungulates, but the main information about these pathogens is related to their effect on farm animals. Data on detection of bovine viral diarrhea virus (BVDV) and bovine herpes virus (BoHV) in wild ungulates reported from different countries in recent years raises the question of the role of wild animals in the epidemiology of cattle diseases., Aim of Work: To study the prevalence of herpesviruses and pestiviruses in the population of wild artiodactyls of the Moscow region., Materials and Methods: Samples of parenchymal organs and mucosal swabs from 124 wild deer (moose and roe deer) shot during hunting seasons 20192022 in Moscow Region were examined by PCR, virological and serological methods for the presence of genetic material and antibodies to bovine infectious rhinotracheitis and viral diarrhea., Results: BVDV RNA was found in a sample from one moose, BoHV DNA was detected in samples from three roe deer and two moose shot in the Moscow region. Seropositive animals were of different sex and age, the total BoHVs and BVDV seroprevalence rates in wild artiodactyls were 46 and 29%, respectively., Conclusion: Wild ruminant artiodactyls of the Moscow Region can be a natural reservoir of BoHV-1, and this must be taken into account when planning and organizing measures to control the infectious bovine rhinotracheitis. Cases of BVDV infection in wild artiodactyls are less common, so more research is needed to definitively establish their role in the epidemiology of this disease in cattle.

The article presents analysis of the program of preventive examinations of Moscow residents in the "Healthy Moscow" pavilions and the routing of patients with established atherosclerosis of brachiocephalic arteries. In 2022, within the framework of preventive examinations (check-ups) of Moscow residents in the "Healthy Moscow" pavilions, the pilot project of organization of surgical treatment of patients with established pathology of pre-cerebral arteries. The project included additional ultrasound examination of brachiocephalic arteries of males aged 45-72 years and females aged 54-72 years. the brachiocephalic artery stenosis was detected in 14 688 out of 370 416 people (4.0% of those passed the check-up). The stenosis was diagnosed in more than 50% - 1 369 people, 9.3% of all stenoses or 0.4% of those passed the check-up). At diagnosis of stenosis, more that 70% of patients were offered to undergo screening ultrasound examination at the "N. V. Sklifosovsky Research Institute of Emergency Care of the Moscow Health Department". The consultation was received by 117 patients out of 254 people. Out of them 22 patients were referred for additional examination, 70 patients for outpatient treatment, 25 patients for surgical treatment. The preventive examination of population organized in the "Healthy Moscow" pavilions permitted to identify sufficient number of patients requiring additional examination with following outpatient and/or surgical treatment of brachiocephalic artery stenosis who timely received necessary care. This result was facilitated by a number of organizational methodological measures implemented jointly with the Moscow Health Department".

Economic and social losses due to epidemics of non-communicable diseases have put prevention and control of them on the first line in the field of sustainable development of the United Nations. The tasks of combating NCDs and risk factors within the framework of the Sustainable Development Goals require targeted actions on the part of States in the field of policy and legislation and provision of health systems with appropriate resources. In the Russian Federation, such work is being implemented within the framework of the national project "Healthcare", federal programs to combat oncological and cardiovascular diseases. Each subject takes into account the peculiarities of economic development, staffing, implementation of informatization processes, etc. The rapid pace of transformation of Moscow healthcare, its unique institutional structure allowed to form the basis for the effective development of a system of proactive dispensary monitoring of patients suffering from chronic diseases. The authors describe the process of formation of preventive work and organization of dynamic dispensary observation in Moscow. The paper presents in detail the organizational, administrative and technological resources used to create a unique system of dynamic dispensary observation. In addition, the article illustrates the personalized subsystem of dynamic dispensary observation in EMIAS and the institute of "physician assistant". The introduction of a proactive dispensary monitoring system will reduce premature mortality and disability among residents of the city. Moscow through an individual monitoring program and motivation for the responsible attitude of metropolitan patients to their health.

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.

Introduction: SARS-CoV-2, a severe acute respiratory illness virus that emerged in China in late 2019, continues to spread rapidly around the world, accumulating mutations and thus causing serious concern. Five virus variants of concern are currently known: Alpha (lineage B.1.1.7), Beta (lineage B.1.351), Gamma (lineage P.1), Delta (lineage B.1.617.2), and Omicron (lineage B.1.1.529). In this study, we conducted a molecular epidemiological analysis of the most prevalent genovariants in Moscow and the region. The aim of the study is to estimate the distribution of various variants of SARS-CoV-2 in Moscow city and the Moscow Region., Materials and Methods: 227 SARS-CoV-2 sequences were used for analysis. Isolation of the SARS-CoV-2 virus was performed on Vero E6 cell culture. Sequencing was performed by the Sanger method. Bioinformatic analysis was carried out using software packages: MAFFT, IQ-TREE v1.6.12, jModelTest 2.1.7, Nextstrain, Auspice v2.34., Results: As a result of phylogenetic analysis, we have identified the main variants of the virus circulating in Russia that have been of concern throughout the existence of the pandemic, namely: variant B.1.1.7, which accounted for 30% (9/30), AY.122, which accounted for 16.7% (5/30), BA.1.1 with 20% (6/30) and B.1.1 with 33.3% (10/30). When examining Moscow samples for the presence of mutations in SARS-CoV-2 structural proteins of different genovariants, a significant percentage of the most common substitutions was recorded: S protein D614G (86.7%), P681H/R (63.3%), E protein T9I (20.0%); M protein I82T (30.0%), D3G (20.0%), Q19E (20.0%) and finally N protein R203K/M (90.0%), G204R/P (73.3 %)., Conclusion: The study of the frequency and impact of mutations, as well as the analysis of the predominant variants of the virus are important for the development and improvement of vaccines for the prevention of COVID-19. Therefore, ongoing molecular epidemiological studies are needed, as these data provide important information about changes in the genome of circulating SARS-CoV-2 variants.

Objective: To analyze the work of the Center for the Treatment of Cerebrovascular Pathology in Children and Adolescents, operating on the basis of the Morozov Children's City Clinical Hospital of the Moscow Health Department for the period 2018-2021 and to assess the peculiarities of organizing the provision of specialized care to children and adolescents with acute cerebrovascular accident (ACA)., Material and Methods: Annual reports of the Center for the period 2018-2021; included children and adolescents aged 1 month to 17 years 11 months 29 days, with new onset ischemic stroke (IS) and hemorrhagic stroke (HS), cerebral venous thrombosis (sinus thrombosis), confirmed clinically and radiologically., Results: Statistical data on stroke and organization of care for children with this pathology in Moscow are presented. The incidence of IS in Moscow for the period 2018-2021 ranged from 1.6 to 2.5 per 100.000 children, HI - from 2.35 to 3.3 per 100.000, sinus thrombosis from 0.5 to 1.38 per 100.000. When assessing the main etiological factors of stroke in The Center for International Pediatric Stroke Research categories, we noted a prevalence of chronic head and neck diseases (20-37%) and chronic systemic conditions (conditions or diseases with known changes in coagulation or vascular structure, including connective tissue dysplasia, genetic, hematological, inflammatory or diseases of the immune system) (15-20%). In addition, data on reperfusion therapy carried out at the Center are presented. From 2018 (first thrombolysis was performed) to 2021, 7.3-14.7% of all patients with IS underwent thrombolysis., Conclusion: The experience of functioning of the Center for the Treatment of Cerebrovascular Pathology in Children and Adolescents has shown that the creation of such centers in the regions of the Russian Federation is relevant, but requires taking into account the characteristics of the pediatric population when organizing their work.

Objective: Describe the structure of pathogenic germline variants and clinical and anatomical features in colorectal cancer patients in Moscow., Material and Methods: The whole genome sequencing results of patients with suspected hereditary cancer syndrome were evaluated. All identified genetic variants were validated using Sanger sequencing., Results: The study included 238 patients with colorectal cancer, 41/238 (17.2%) patients have pathogenic germline variants associated with hereditary cancer syndromes or increased cancer risk. Lynch syndrome accounts for 8% of all colorectal cancer cases (19/238), and familial adenomatous polyposis - 1.7% (4/238). 5 new genetic variants were described for the first time in a Russian colorectal cancer patients: MLH1 c.1921dup (p.Leu641fs), APC c.2929C>T (p.Gln977Ter), PMS2 c.327del (p.Ala110LeufsTer2), MSH2 c.1857dup (p. Val620CysfsTer24), ATM c.895G>T (p.Glu299Ter). In 197 of 238 patients, no significant variants were identified or variants with an uncertain clinical underlying cause were identified., Conclusion: According to the results of the study, an earlier manifestation of a malignant neoplasm and a more frequent occurrence of high-grade carcinomas in the presence of pathogenic germline mutations were noted compared to the group of patients without clinically significant varianrs, while in the group with identified mutations, the frequency of regional and distant metastasis was not increased.

According to the statistical forms medical and preventive treatment centres (MPTC), the analysis of dynamic indicators of the treatment of patients with acute sinusitis (AS) in outpatient polyclinic centers (OPC) and ENT hospitals in Moscow for the period from 2017 to 2021 was carried out. The total number of visits to an otorhinolaryngologist in the OPC in Moscow for 2017-2021 amounted to 6 834 952 patients, including 245 172 patients with AS (3.6%).The total number of hospitalizations in the departments of otorhinolaryngology for the same period amounted to 184 735 patients, including 12 906 patients with AS (7%).The number of patients with AS who was consulted by an otorhinolaryngologist from 2017 to 2021 decreased by 18.2%, which can be explained by a change in the routing of patients with mild form of AS to general practitioners. An analysis of the dynamic indicators of maxillary sinus punctures carried out in the medical and preventive treatment centres (MPTC) in Moscow during the period from 2017 to 2021 showed that there was a redistribution of this manipulation from ENT hospitals to the OPC. At the same time, the proportion of patients requiring puncture treatment in the OPC for 2017-2019 was stable and amounted to 9.3%. However, since 2020, there has been an increase in this indicator by more than 2 times (21.7%), which probably indicates an increase in the treatment of patients with moderate forms of AS in the OPC. The frequency of maxillary sinus punctures that were performed in ENT hospitals in 2017-2019 amounted to 83.5%, in 2020-2021 decreased to 63.4%. The average number of maxillary sinus punctures per patient in ENT hospitals from 2017 to 2019 was 13.3. Since 2020, this value has decreased by about 2 times and has become equal to 8.5. The decrease in the number of maxillary sinus punctures that were performed in ENT hospitals is probably due to the fact that patients with severe and complicated forms of acute sinusitis hospitalized from 2020 to 2021 required more radical surgical treatment.

The Aim of the Study: Was to compare the prevalence and structure of sudden death from cardiovascular diseases (CVD) in the structure of nonviolent death in Moscow Region as a representative of the large region and St. Petersburg as a city of federal importance. Frequency and structure of this parameter, as well as its dynamics were analyzed. The comparison of obtained results with data of Federal State Statistics Service was done. Nonparametric analysis of the initial data has been conducted. Clustering and visualization, based on the following parameters of initial sample, have been done: «death rate from CVD in the structure of nonviolent death», «morbidity rate», «incomes» and «unemployment rate». Correlation dependences between death rate from CVD according to the Form №42 and mentioned parameters of medical and social state of the subject have been determined. Dependences between sudden death rate from CDV and a number of medical and social parameters have been established.

Objective: Determination of the leading causes of death based on data from primary medical death certificates (MDCs) depending on the place of death., Material and Methods: From the electronic database of the Main Department of the Civil Registry Office of the Moscow Region (the USR registry office system) for 2021, all cases were selected in which diseases were indicated as the primary cause of death (PCD); all codes of external causes, injuries and poisonings were excluded. A total of 109.126 cases, 50.6% died in the hospital, 34% died at home, and 16.4% died elsewhere. Bureau of Forensic Medical Examination (BFME) issued 45.2% of MSS. Taking into account the frequency of use of ICD codes, the clinical similarity of individual codes, 20 groups were formed, which accounted for 90.1% of deaths from diseases., Results: The frequency of registration of individual groups of causes of death largely depends on the place of death. 5 leading groups of causes of death were established: 1) in general from COVID-19 23.55%, chronic ischemic heart disease (CIHD-1) without postinfarction cardiosclerosis, aneurysm and ischemic cardiomyopathy (CMP) 14.5%, from encephalopathy indefinite (EI) 11.4%, malignant neoplasms (MN) 11.3%, stroke 6.2%; 2) in a hospital from COVID-19 45%, stroke 10%, MN 8.3%; CIHD-1 7.1%, CIHD with a history of MI/ischemic CMP 2.7%; 3) at home from CIHD-1 21.8%, EI 21.5%, MN 15.5%, from diseases associated with alcohol 3.3% and brain cyst 3.3%; 4) elsewhere from CIHD-1 22.7%, EI 21.6%, MN 12%, from other forms of acute coronary artery disease 5.4%, alcohol-associated diseases 4.8%. Acute MI ranked 6 th among deaths in general - 2.7%. PCD is also associated with the place of issue of the MDCs - 90% of the MDC with the indication of EI and «other degenerative diseases of the nervous system» as the cause of death were issued by the BFME. Not a single MDC issued by the BFME contained such PCDs as "old age" or "brain cyst"., Conclusion: The nosological structure of the causes of death and the issuance of individual ICD codes in the MDC as a PCD varies significantly depending on the place of death and the issuance of the MDC. The reasons need to be further clarified. The use of codes that are not permitted for use has been registered.

Background: Currently, obesity is considered one of the most significant health problems, representing a common chronic disease leading to the development of severe comorbidities, accompanied by the loss of disability-adjusted life years and high mortality. Due to the fact that obesity is one of the leading risk factors for a number of non-communicable diseases, such as diseases of the circulatory system, diseases of the endocrine system and malignant neoplasms., Aims: assessment of adult mortality dynamics from obesity-associated causes in Moscow compared to the Russian Federation in 2011-2020., Materials and Methods: data from the analytic package FAISS (internal use program): standardized mortality rates for population of Moscow and the Russian Federation as a whole., Results: Over the 10-year period under study, mortality in the class of diseases of the circulatory system and malignant neoplasms was decreasing, while mortality from diseases of the endocrine system was increasing. Adult mortality from the diseases of the circulatory system in Moscow reduced by 12%, in the Russian Federation - by 25%. It should be noted, that mortality rate in Moscow (302.5 per 100,000) is significantly (by 34%) lower than in Russia (460.3), at the same time, the rate of mortality reduction over a 10-year period is equal and amounts to 23-25%. Myocardial infarction is the most serious obesity-associated disease characterized by high mortality in the class of the diseases of the circulatory system, it has a declining trend in Moscow and in the Russian Federation as a whole. Adult mortality from the diseases of the endocrine system in Moscow increased by 3 times, and in the Russian Federation - by almost 5 times, while the annual increase during the first year of the pandemic was 88% in Moscow and 24% in Russia. In Moscow, more than a half (66%) of deaths from endocrine causes belongs to non-insulin-dependent diabetes mellitus, in the Russian Federation - about 80%. Compared to the Russia's average, in Moscow mortality rates from neoplasms are lower by 8%, but at the same time, the decline happens at a similar rate (11-12%)., Conclusions: Despite the impact of the COVID-19 pandemic, Moscow demonstrates slowdown of growth of mortality rates from obesity-associated diseases compared to the Russian Federation, which could have been positively affected by prevention programs of noncommunicable diseases and promotion of healthy lifestyles.

The article presents information on trends in hospital morbidity of child population in Moscow, as well as morbidity of children in the first year of life. Authors used population data and information from Form No. 14 of the Federal statistical observational study "Information on the activities of the medical organization departments providing inpatient medical care" between 2014 and 2021.In addition to the general indexes, the article presents categories of diseases that were significantly affected by changes in the lifestyle of children during the COVID-19 pandemic. Significant fluctuations in the incidence of infectious diseases are worth noting as they are certainly related to both fragmentations in groups of children during the pandemic, and proper nutrition, which led to positive changes in hospital morbidity due to gastrointestinal disorders. Changes in education, social isolation, better control over hygiene by the government, society and parents has led to unprecedented positive dynamics in morbidity rates of certain diseases. It is worth noting that the COVID-19 infection during pregnancy didn't lead to expected high increases in morbidity rates associated with diseases in the perinatal period.In addition to hospital morbidity, the article presents data on mortality in 24-hour inpatient facilities, as well as changes in the proportion of emergency admissions of patients under 18 to Moscow state hospitals.

An important goal of COVID-19 surveillance is to detect outbreaks using modern molecular epidemiology techniques based on methods to decode the full genome of the virus, since rapidly evolving RNA viruses, which include SARS-CoV-2, are constantly accumulating changes in their genomes. In addition to using these changes to identify the different virus lines spreading in the population, the availability of sequence information is very important. It will allow the identification of altered variants that may be more transmissible, cause more severe forms of disease, or be undetectable by existing diagnostic test systems. The global scientific community is particularly interested in changes in the spike protein (S-protein, Spike) because they are responsible for binding and penetration into the host cell, lead to false-negative results in diagnostic tests, and affect transmission rates, health outcomes, therapeutic interventions, and vaccine efficacy.Genomic surveillance uses next-generation sequencing (NGS) applications and makes data on the full genome of the virus available. These methods offer new means to detect variants that differ phenotypically or antigenically. This approach promotes earlier prediction as well as effective strategies to mitigate and contain outbreaks of SARS-CoV-2 and other new viruses long before they spread worldwide.Today, molecular typing of strains is playing an increasingly important role in this process, as it makes it possible to identify samples that share a common molecular «fingerprint».

The article is a comparative analysis of the quality of life indicators of patients with rheumatoid arthritis with similar indicators in the Moscow population. We conducted a survey of patients in the register of rheumatoid patients in Moscow using the EQ-5D-5L questionnaire and the EQ-VAS visual analog scale. The population of patients with rheumatoid arthritis, in accordance with the recommendations of EuroQoL, was divided into 6 age and sex groups. The responses of patients from each age and sex group were compared with similar groups of respondents in the Moscow population. Key differences in the quality of life of rheumatoid patients were identified in comparison with both the population norm in Moscow and similar foreign registries.

Introduction: The study of the intensity of humoral immunity to the measles virus (Paramyxoviridae: Morbillivirus) (MV) remains relevant due to the ongoing registration of the cluster cases of measles (including nosocomial cases).The aim of the study was to analyze correlation between the intensity of the humoral immunity to measles virus and the measles incidence in different age groups of the Moscow residents., Material and Methods: A simple analytic study was carried out under the framework of measles prevention improvement program conducted in the subjects of the Russian Federation. The study included the analysis of the reasons for the increase in the proportion of seronegative individuals and the comparison of the results of seromonitoring with the data of age-related measles incidence. Throughout 2018, total 1,855 blood serum samples obtained from employees of a large hospital center in Moscow who were previously vaccinated against measles were tested for IgG antibodies (ABs) to MV. The subjects were divided into 11 groups according to their age. Statistical analysis of the obtained data was performed using nonparametric criteria., Results and Discussion: The proportion of seronegative individuals among the staff of the medical facility decreased with age, from 38.5% in persons aged 19-23 to 0% among employees aged 64 and over. Persons aged 19-43 years were the most susceptible to measles infection, which was confirmed also by the highest incidence rate at these age groups (from 6.93 to 14.03 per 100,000 population). The age group most protected against measles was those over 64 years of age, who were all seropositive and had the lowest rates of incidence. This is probably due to the fact that by this age most of them have had a measles infection and have formed a sufficient immune response. At the same time, younger individuals living in the post-elimination era have only vaccine-induced ABs to MV, the level of which declines rapidly to non-protective values in the absence of boosterization due to the exposure to the wild-type strain of the pathogen., Conclusion: The monitoring of the MV-specific IgG- AB levels is required for employees in the medical institutions under the age of 35. Administration of the single dose of the appropriate vaccine is recommended for seronegative individuals.

The article presents the results of analysis of repeated disability because of thyroid cancer in adult population of Moscow in 2015-2019. The study established negative dynamics of increasing of the number of individuals with repeated disability because of thyroid cancer in all essential age contingents (young, middle and elderly age) of adult population. The similar trend was revealed in gender contingents of individuals with repeated disability because of thyroid cancer (in males, increase was made up to 112.5% and in females up to 196.3%). In the gender and age structure of repeated disability because of thyroid cancer, predominated females and the elderly. The study established dynamics of decreasing of percentage of individuals with repeated disability because of thyroid cancer of the disability groups I and III and corresponding increasing in disability group II. The percentage of individuals with repeated disability because of thyroid cancer in disability groups I and II was higher in males as compared with females. Most individuals with disabilities because of thyroid cancer don't work. The study results make available spectrum of disorders of main functions of organism, their degree and types and intensity of limitations in vital activity of individuals with repeated disability because of thyroid cancer. The organized database of characteristics of repeated disability because of thyroid cancer in adult population can be used in implementation of personalized approach to medical social rehabilitation of increasing number of disabled individuals with malignant damage of the most important organ of endocrine system.

The presents an analysis of the trend of the postmortem ethanol tests in biological samples obtained from the deceased in Moscow in April-May 2019 and 2020. In total, 7110 reports of forensic chemistry studies were examined; all cases were classified by the age of the deceased, following the modern generational theory to study patterns of alcohol consumption in these age groups and the impact of the COVID-19 pandemic. Stable patterns of alcoholic behavior were revealed in the groups of the deceased. It was shown that, on average, every 3rd representative of Generations «X» and «Y» consumes alcohol shortly before death; the highest average blood ethanol levels were found in representatives of Generations «Y» and «X». The number of positive ethanol test results increased in April-May 2020 among males of the baby boom and Generation «X» compared to the same period in 2019. The patterns identified can be used to further study the contribution of alcohol consumption to mortality.

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.

The analysis of level and structure of general and primary morbidity according to medical care appealability of Moscow population during implementation of the State program "The Development of the City of Moscow Health Care (Metropolitan Health Care) in 2012-2020" was carried out according to the data from collections of main indices of functioning of medical organizations subordinated to the Moscow Health Care Department and health indices of Moscow population. The decreasing of both primary and general morbidity indices is established. At that, increasing of the life expectancy indices was marked. At the same time, population morbidity indices according to medical care appealability are not sufficiently reliable in assessing degree of achievement of results of any measures of improving population health due to their dependence on multitude of factors.

The purpose of the study is to to identify key social and medical problems of childhood psychiatry by analysis of statistical and clinical data of Moscow health care institutions. It is established that actual problems are related to increasing of incidence of morbidity of mental disorders in children, their late detection, absence or unavailability of diagnostic techniques with high evidentiary effect, inability to use modern achievements of psychopharmacotherapy, close relationship of mental disorders with social factors, as well as with high stigmatization of mental health sphere. It is necessary to intensify research in studying etiopathogenetic factors, elaborating strategies of mental disorders prevention in childhood, clinical trials targeted to expand age range of application of medications and to icrease activities on destigmatization and psychoeducation in society.

Introduction: Since the outbreak of the COVID-19 pandemic caused by SARS-CoV-2 novel coronavirus, the international community has been concerned about the emergence of mutations altering some biological properties of the pathogen like increasing its infectivity or virulence. Particularly, since the end of 2020, several variants of concern have been identified around the world, including Alpha (B.1.1.7), Beta (B.1.351), Gamma (P.1), and Delta (B.1.617.2). However, the existing mechanism of detecting important mutations are not always effective enough, since only a relatively small part of all pathogen samples can be examined by whole genome sequencing due to its high cost., Material and Methods: In this study, we have designed special primer panel and used it for targeted highthroughput sequencing of several significant S-gene (spike) regions of SARS-CoV-2. The Illumina platform averaged approximately 50,000 paired-end reads with a length of ≥150 bp per sample. This method was used to examine 579 random samples obtained from COVID-19 patients in Moscow and the Moscow region from February to June 2021., Results: This study demonstrated the dynamics of distribution of several SARS-CoV-2 strains and its some single mutations. It was found that the Delta strain appeared in the region in May 2021, and became prevalent in June, partially displacing other strains., Discussion: The obtained results provide an opportunity to assign the viral samples to one of the strains, including the previously mentioned in time- and cost-effective manner. The approach can be used for standardization of the procedure of searching for mutations in individual regions of the SARS-CoV-2 genome. It allows to get a more detailed data about the epidemiological situation in a region.

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.

Introduction: Liver cirrhosis is a major but preventable cause of health loss worldwide. The era of «big data» allows us to evaluate this nosology in a new format., Purpose: Evaluation of the registered population of patients with cirrhosis of the liver of cirrhosis of various etiology in Moscow. Moscow., Materials and Methods: Based on the data of the Moscow Department of Healthcare for the drug provision for the period from 2017 to 2019. Тhe population of patients with an established diagnosis of liver (other etiology) was characterized according to ICD-10 code K.74 (K74.0-74.6) according to the International Statistical Classification of Diseases and Related Health Problems of the 10th revision., Results: Over a 4-year period, more than 2 thousand patients with established diagnosis of liver cirrhosis received preferential drug provision in Moscow. The largest part of the population of patients with liver cirrhosis receiving preferential drug provision in Moscow is represented by the patients of age groups 40-59 years old and 60-79 years old, the groups 30-39 years old and 80-99 years old were comparable annually. There was a decrease in the number of patients with liver cirrhosis in the age groups of 30-39 and 18-19 years compared with the base year (2017) by 37% and 57%, respectively. At the same time, in pediatric patients (from the neonatal period to 17 years), there was an intensive increase in patients from 52 to 550% compared to the baseline year (2017).

Ensuring effective epidemiological surveillance of tuberculosis is essential and one of the paramount tasks for any national tuberculosis control program. The article analyzes the organization of the tuberculosis epidemiological monitoring system at the level of the subject, based on the experience of implementing such a system in the city of Moscow in 1996-2020, defines its tasks and principles of its construction. The systems of epidemiological monitoring of tuberculosis, implemented taking into account the developed principles, provide an analysis of the epidemiological situation in the territory, the results of which can be successfully used for making managerial decisions, program-target planning and evaluating the effectiveness of the measures taken.

The article presents the experience of the city children's polyclinic No. 133 of the Moscow Department of Health in a difficult epidemiological situation associated with a new infection COVID-19. A description of the stages of the organizational work of a polyclinic in a pandemic is given, including such areas as: a) conducting lectures and webinars for doctors and nurses of a medical organization, introducing recommended methods for diagnosing and treating COVID-19, creating and observing conditions for the personal safety of employees; b) the formation of tools and a database for analytical work; creation of registers of patients and employees of the polyclinic in order to monitor and evaluate the effectiveness of work; characteristics of the structures of age-specific morbidity in children who have undergone a new coronavirus infection and community-acquired pneumonia with substantiated confirmation for them of compulsory dispensary observation and rehabilitation measures; description of the development of routing of healthy and sick children, operational identification and continuous analysis of difficulties in the work of the polyclinic during this period; c) the formation of distance technologies in treatment and prophylactic work with patients, organized group and individual exercise therapy classes, including respiratory rehabilitation gymnastics for children who have undergone a new coronavirus infection; development of an organizational algorithm for the formation of medical and nursing teams for visiting patients with COVID-19 at home and individual teams for visiting patients for patronage. The organization of this treatment and prophylactic work was approved and a confirmation was received from the Ministry of Health of the Russian Federation of the right to replicate the experience gained from the work of the polyclinic in the conditions of COVID-19.

It is known that the oral cavity is an epidemiological hazard due to the high level of viral and bacterial contamination. Despite the narrow specialization and distant connection with the problem of viral pneumonia, dentists, nevertheless, are at risk of contracting the new coronavirus infection COVID-19. To reduce the epidemiological activity the provision of routine dental care was suspended in the vast majority of regions of the Russian Federation including the Moscow region, from the end of March 2020 to June 20, 2020. During the entire period of routine medical care suspended, the Moscow region chief dentist's team was daily monitoring information about applied patients. The suspension of routine medical care has reduced the number of cases of COVID-19 infection contact transmission in medical organizations during the period of the most active increase in the morbidity. In addition, the decrease in the number of patients enabled medical organizations to reduce the number of medical personnel, which contributed to a decrease in the percentage of morbidity among doctors.

About 30% of male infertility is associated with genetic abnormalities. Genetic polymorphisms increase the level of individual susceptibility to adverse environmental factors and affect human reproductive function., Aim: To study associations of glutathione S-transferase GSTP1(Ile/Val) gene polymorphisms (A313G; rs1695) with the risk of pathospermia in men of the Moscow region., Materials and Methods: We examined 138 men in the Moscow region (n=70 - proven pathospermia, n=68 - fertile men). We obtained genomic DNA from blood leukocytes and studied the gene polymorphisms of glutathione-S-transferase GSTP1 (Ile/Val) (A313G; rs1695) in real time., Results: In the analysis of the distribution frequencies of polymorphisms GSTP1 (Ile/Val) (A>G rs1695), we revealed the predominance of the AA genotype in fertile men and the predominance of the GG genotype (homozygous minor allele) in men with pathospermia. However, we found no significant difference in these parameters between the compared groups of patients (p=0.344). For GSTP1 (Ile/Val) polymorphism (A313G, rs1695), significant differences in the distribution of genotype frequencies in the subgroup of men with teratospermia (2=7.00; p=0.03) were revealed. The frequency of allele G in the subgroup of men with teratospermia is statistically significantly different from the frequencies of alleles in the control group: 52% versus 30% (2=10,004; p=0.0015). In subgroups of men with azoospermia and asthenospermia, we did not find significant differences in the distribution of genotypes of GSTP1 polymorphism (rs1695) (p>0.05)., Discussion: Glutathione-S-transferase (GSTP1) is a multifunctional protein that protects sperm cells from the damaging effects of reactive oxygen species and xenobiotics. The Association of GSTP1 polymorphism (Ile/Val) (A313G, rs1695) with teratospermia explains the main stages of the pathogenesis of male infertility in this category of patients., Conclusion: Gene polymorphism GSTP1 (A313G, rs1695) can be considered a genetic marker of susceptibility to pathospermia in men.

Aim        To analyze first results of using the Aterostop calculator for a comprehensive evaluation of the risk for cardiovascular diseases (CVD).Material and methods        A cross-sectional study analyzed major and additional risk factors in 460 subjects without apparent disease and in patients with documented CVD of atherosclerotic origin using the application (calculator) Aterostop developed in the National Medical Research Center of Cardiology in Moscow, Russia.Results   45.4% of evaluated persons belonged to the categories of very high and extreme risk. Age and frequencies of smoking, arterial hypertension, and diabetes mellitus (DM) increased with the increase in risk; the growth of DM was exponential. 129 (28%) individuals used lipid-lowering medications at the time of study. Their plasma levels of low-density lipoprotein cholesterol (LDL-C) were significantly lower than in those who did not received this treatment. However, achieving the target level was inversely proportional to the risk: the greatest proportion of individuals who reached the LDL-C target was in the category of low risk and the smallest proportion was in the category of extreme risk (75 % vs. 3.7 %, respectively).Conclusion            The results obtained with the calculator Aterostop were consistent with earlier reports of insufficient effectiveness of primary and secondary prevention of atherosclerotic CVDs, which requires more tight and fruitful cooperation of the physician and the patient.

The article presents the dynamics of disability due to cerebrovascular diseases in 2014-2018 in Moscow. The age gender analysis of the disabled in this category was carried out. It was established that 30% of total population of the disabled due to cerebrovascular diseases accounted for the share of those who were recognized as disabled for the first time in the structure of total population. The most frequently disabled persons are those who are older than able-bodied age. In total structure of the disabled due to cerebrovascular diseases, women predominate.

To preserve the country's population is among one of the most vital tasks over the period of existence of the new Russia and constitutes the subject of national security. The article presents the results of analysis of population mortality rate of the Russian Federation, the Central Federal Okrug and City of Moscow during the first eight months of 2020 towards to concurrent period of 2019. In January-March 2020, the population total mortality rate, retaining prevalent trends of number of preceding years, decreased in the Russian Federation by 3.8%, in the Central Federal Okrug by 3.0% and in City of Moscow by 3.9%. However, since April-May the situation has changed dramatically and, according to the results of January-August, mortality by this time has increased, and its growth made up to 6.5% in the Russian Federation, 7.8% in the Central Federal Okrug and 15.6% in the City of Moscow. In May 2020, the gain of absolute number of the deceased in the Russian Federation by months (towards to concurrent month of 2019) made up to 11.9%, in June to 18.6%, in July to 19.7% and in August to 9.6%. In Moscow, the peak values of this increase were noted in May - 57.2% and in June - 41.6% In the conditions of new coronavirus infection pandemic, the share of COVID-19, as main cause of death (ICD-10 codes U07.1 and U07.2), in the structure of total mortality in April-August consisted 3.2% and in the structure of excess deaths in May-August - 28.6%. The increase of mortality and continued decrease of birth rate resulted in increasing of natural population loss by 1.5 times and more and reached such values as -3.6 in the Russian Federation, -4.9 in the Central Federal Okrug and -1.6 in the City of Moscow (per 1000 of population). The process of depopulation of the Russian nation not only retained, but significantly has become significantly aggravated.

The results of the analysis of primary disability due to thyroid cancer of the adult population of Moscow in the period 2015-2019 are presented. An increase in the number of peaple newly recognized as disabled (PNRD) due to this pathology was revealed. In the age structure of primary disability elderly people was dominated. The predominant gender contingent of the PNRD were women. It was found that the predominant number of PNRD had a moderate impairment (II degree) of the basic functions of the body. At the same time, gender differentiation in the severity of persistent impairment of the body functions among disabled was revealed. In the contingent of disabled men the proportion of persons with severe (III degree) and complete (IV degree) impairment of the function of the blood system and the immune system and with a severe impairment of the function of the endocrine system and metabolism was higher compared to the contingent of disabled women. It was determined that the main types of capacity limitations were self-care, work, moving and communicate limitations (the first degree of difficulties in life areas prevailed (p<0,05). Thyroid cancer, due to the rapid growth of morbidity and disability, is an important public health concern. The study of disability indicators of the population is necessary for the development of rational measures of medical and social rehabilitation of patients suffering from thyroid cancer, and for the implementation of medical and social prevention of disability.

Objective: To study the features of the formation of gender reassignment`s ideas in schizophrenia spectrum disorders and to differentiate diagnosis of these psychopathological formations with transsexualism., Material and Methods: The study was carried out in the Department of Sexology and Therapy of Sexual Dysfunctions of the Moscow Research Institute of Psychiatry - a branch of the Serbsky National Medical Research Center for Psychiatry and Narcology in the period from October 2018 to May 2020. The study included 100 outpatients referred for gender reassignment. The subjects were divided into two groups. The first group consisted of 58 patients with schizophrenia spectrum disorders (Paranoid schizophrenia, F20.0; Schizotypal disorder, F21; Chronic delusional disorders, F22) with ideas of sex change. The second group included 42 patients with a diagnosis of «Transsexualism» (F64.0). Clinical-psychopathological, pathopsychological and statistical methods were used., Results: Patients with transsexualism are statistically significantly more often adapted in terms of work and family, have experience of life in the desired gender, use hormone therapy and gender-affirmative interventions before undergoing a medical commission on gender reassignment and less often hospitalized in psychiatric hospitals, compared to patients with schizophrenia spectrum disorders ( p <0.05). Patients with schizophrenia are more likely to experience delays and disharmony in psychosexual development. Sex reassignment ideas are more common in schizotypal disorder than in other types of schizophrenia., Conclusion: Ideas of gender reassignment in schizophrenia spectrum disorders, as a rule, are formed on the basis of existing deviations in the early stages of the formation of gender identity. The central place in the psychopathology of schizophrenia spectrum disorders with ideas of gender reassignment is occupied by depersonalization-dysmorphophobic experiences with the following formation of overvalued, delusional or paranoid ideas of sex reassignment.

Objective: To analyze the development of surgical approaches for hepatic echinococcosis., Material and Methods: We have analyzed diagnosis and treatment of 349 patients with liver echinococcosis; 97 patients were treated at the Botkin Clinical Hospital for the period from 2009 to 2019 and 252 patients were treated in surgical hospitals of Moscow city for the period from 2014 to 2019., Results: General and specific postoperative complications, relapses and surgical approaches were assessed. The number of echinococcectomies performed in surgical hospitals of Moscow is 3 times higher compared to the Botkin Hospital. The number of liver resections is comparable in both groups. The number of pericystectomies is more than 2 times higher in the Botkin Hospital. PAIR technique was more common in surgical hospitals of Moscow., Conclusion: Evolution of surgical treatment from open echinococcectomy to anatomical liver resections and subsequent pericystectomy with PAIR technique becomes another round of evolutionary spiral in the development of surgical treatment of liver echinococcosis.

The spinal muscular atrophy is neuromuscular disease caused by mutations in SMN1 gene. The clinical picture of disease is characterized by progressive muscular weakness and atrophy associated with degeneration of spine, and in severe cases by affection of motor neurons of lower bulbar cells. The spinal muscular atrophy progressing course resulting in disability and infant mortality. Actually, specific treatment is at the stage of clinical trials. However, patients are needed in permanent symptomatic arresting of manifestations and pathogenetic treatment preventing development of disease. The article presents calculations of direct medical costs for treatment in pediatric patients (0-17 years old) in Moscow with the main types of spinal muscular atrophy. It is established that the cost of specialized medical care of children with spinal muscular atrophy per single under age patient in Moscow consisted 7,131,185.84 rubles annually, including primary diagnostic, treatment and rehabilitation and medicinal treatment. In total, according to data for 2020 in Moscow, where number of children patients is 144, the cost of specialized medical care of children with spinal muscular atrophy is estimated as 1,024,580,269.16 rubles. At that, data takes into account only direct medical costs for out-patient and in-patient care of children with spinal muscular atrophy, excluding number of exacerbations of disease. Taking into account average numbers of hospitalizations per year because of illness, the cost of in-patient care of single child amounts to 7,844,304.42 rubles annually and 1,127,018,732.08 rubles for all children with spinal muscular atrophy in Moscow (according data of 2020).

Epistaxis or nosebleeds (NB) are the most common emergency pathology that otorhinolaryngologists have to deal with. Purpose of the work: to study the prevalence of patients with NB in the otorhinolaryngological departments of hospitals in Moscow from 2003 to 2019. The reports of the heads of the ENT departments of the city clinical hospitals in Moscow were studied. Inclusion criteria were hospitals working with an adult contingent of patients. An approximation analysis was carried out and trend indicators of the prevalence of NB were studied., Results: 2003 to 2019 the total number of patients treated in ENT hospitals was 563 189 people, 20 623 (3.7%) patients were treated with NB, of which 52 (0.25%) died. The average age of the deceased was 64.7 years, men are 73.7% more prevalent than women. In 96.2% of patients, epistaxis was a complication of the underlying disease, and in 3.8%, it was regarded as a concomitant condition. In 30.8% of the deceased, NB recurred with the background of malignant lesions of the nose and nasopharynx, in 69.2% - posthemorrhagic anemia aggravated diseases of other organs and systems. Over the past 17 years, there has been a tendency for the growth of treated patients with diseases of ENT organs and patients with nosebleeds by 58.5% and 51.1%, respectively. The studied approximation of the relative prevalence and mortality rates in patients with NB showed that for the period from 2003 to 2019. trend values are practically at the same level with the minimum multidirectional linear dynamics - -0.24% and +0.04%, respectively.

Obesity is one of the most important and actual problems of public health, of healthcare, which dramatically expanded through the latest four decades. The aim of the study was the analysis of physical conditions of Moscow preschoolers at the beginning of 21th century as the indicator of nutritional status in «obesogenic» environment of megalopolis. Material and methods . Complex anthropometric study of children attending kinder gardens in Moscow (aged 3-7 years) was held in 2005-2006 (n=759). Literature data on samples of the 1970s were used for comparison. Anthropometric measurements were used to calculate personal values of body mass index (BMI, kg/m 2 ). The more detailed estimation of somatic specificity of children included calculation of average values of standardized differences of each single body dimension of material of 2005-2006 from the values of samples of the 1970s. Results and discussion. The distribution of BMI of Moscow preschoolers at the beginning of 21th century (13.6% were overweight and 7.5% were obese) is quite comparable to the results of other population studies in Russia and around the world. The circumferences, mediated by adipose tissue, and skinfolds of modern Moscow preschoolers showed very significant increase of average standardized levels of dimensions (0.9-1.1 standard deviations as compared to the data of the 1970s). The comparison with the results of the similar study of Moscow school children allows, probably, to speak about the existence of accumulation effect as the mechanism of obesity development in the age aspect. Conclusion . The effect of the significant and valid increase of adiposity in preschoolers, combined with very modest changes of the size and shape of skeletal/muscle system and even its relative weakening was shown based on the results of the survey of Moscow preschoolers, conducted in 2005-2006, in comparison with the series of the 1970s., Competing Interests: The authors declare no overt and potential conflict of interest related to the publication of this article., (Copyright© GEOTAR-Media Publishing Group.)

Purpose of the Study: The purpose is to study the spectrum of bacterial pathogens that cause acute purulent otitis media (APOM) in children of the Moscow region in modern conditions and assess their sensitivity to the main groups of antibiotics., Material and Methods: The study included 1.864 children who underwent examination and received treatment in the otorhinolaryngological department of Morozovskaya Pediatric Municipal Clinical Hospital in the period from 01 July 2018 to 31 June 2020 with a diagnosis of APOM., Results: The study showed that the leading bacterial pathogens of APOM are Streptococcus pneumoniae (28.0%), Staphylococcus aureus (27.2%), Streptococcus pyogenes (22.2%), Haemophilus influenzae (7.8%), and Pseudomonas aeruginosa (6.5%). Attention is drawn to the increase in the level of resistance of S. pneumoniae to oxacillin (11.64%)., Conclusions: The data obtained indicate the feasibility and prospects of vaccination against pneumococcal infection as one of the ways to curb the spread of resistance of S. pneumoniae to antibacterial drugs.

The purpose of the study was to analyze the types and volumes of treatment and prophylactic services provided to the adult population with infectious diseases in the dental office of a multidisciplinary hospital., Materials and Methods: The types and volumes of dental care provided to the adult population with infectious diseases in a multidisciplinary hospital have been analyzed., Results: The study showed that dentists use 49 types of services when treating adults with infectious diseases, which corresponds to 29.88% of the compulsory medical insurance classifier in Moscow. Provided services can be conditionally divided into 4 groups: consultation, diagnostic, preventive and medicinal manipulations. The share of consulting services corresponds to 18.16±0.41% of the total volume of services provided; on average patients made 320.8 visits to the dentist's doctors per year, which corresponds to 2.38 visits for each patient. The proportion of medicinal manipulations, diagnostic and preventive services corresponds to 68.64±0.49%, 7.02±0.27% and 6.17±0.26%, respectively. Services related to the diagnosis and treatment of diseases of the oral mucosa and salivary glands dominate with 69.3%, on average 5.51 services are provided per visit., Conclusion: The compulsory medical insurance program for the city of Moscow should provide services for the diagnosis, treatment and prevention of dental diseases, provided by doctors specializing in «dentistry», for patients with infectious diseases who are undergoing treatment in inpatient conditions.

Aim: To compare dental and psychological status in athletes of Olympic teams and the population of Moscow., Materials and Methods: In order to study the features of the dental rehabilitation of Olympic athletes, a comparative study of the dental and psychological status of 132 athletes was carried out when they were included in the Olympic teams and 104 residents of Moscow of the same age. Clinical x-ray examination was supplemented by «Hamburg testing» of the masticatory apparatus and psychological examination using common questionnaires and scales., Results: The study revealed a difference in the status of dental status, the results of the "Hamburg Testing" and psychological examination between athletes of the Olympic reserve and the population of Moscow of the same age. Athletes showed a lower quality of previous treatment of caries and its complications, insufficient oral hygiene, more frequent detection of chronic periodontitis, diseases of the oral mucosa, secondary deformations of the dentition, pathological phenomena of the temporomandibular joint, masticatory apparatus dysfunction according to the results of the "Hamburg Testing". Athletes also established psychological status features: higher rates of reactive and personal anxiety, the presence of depressive manifestations, lower quality of sleep and quality of life., Conclusion: The revealed patterns can provoke muscle hyper-tone and muscular-articular dysfunction of the maxillofacial region, which must be taken into account during the dental rehabilitation of athletes of Olympic teams.