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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: A comparative analysis of symptoms in arterial ischemic and stroke-like conditions in children, the development and analysis of the «Presumptive stroke in children» scale for prehospital diagnosis of ischemic strokes in children., Material and Methods: This article analyzes cases of emergency hospitalization of children in a stroke center with suspected cerebrovascular pathology as well as the symptoms of patients with suspected ischemic stroke, compares the leading and final diagnoses, identifies the main «mimics» of stroke and their symptom complexes. A comparison of the obtained data with the results of previous studies was carried out., Results: The results show the prevalence of motor disorders and coordination disorders in cases of ischemic stroke and cerebral symptoms in cases of stroke-like conditions in children. The most frequent stroke-mimic is migraine. Based on the results of the study, we propose a screening scale for pre-hospital diagnosis of ischemic stroke in children. A preliminary assessment of the effectiveness of the scale using examples of cases of confirmed stroke and stroke-mimic was performed., Conclusion: Timely hospitalization of children with stroke can not only reduce mortality, but also use modern diagnostic and treatment methods to reduce the volume of brain damage with a possible complete restoration of motor and cognitive functions. Further analysis of the sensitivity and specificity of the «Presumptive stroke in children» scale is required.

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.

Bleeding is a life-threatening condition, requiring an urgent care. The first line of treatment this kind of patients is ambulance doctors (emergency medical team). Spontaneous bleeding (SB), in this case, don't have a traumatic agent (including surgical trauma)., Study Objective: The purpose of this study was to evaluate spontaneous bleeding epidemiological profile of Moscow city emergency service., Methods: Study included statistical reports of Moscow city emergency services medical teams (EMT) were servicing adults. We analyzed total number of calls and number of EMT calls to pa-tients with SB during the period between 2015 and 2019. The excluding criteria was EMT re-calls to patents with SB., Results: In a study, it was found that over five-year period of observation, EMT made 15 709 862 calls, included 215 840 calls (1.37%) to patients with SB. It was found that the most frequency sources of SB were: the gastrointestinal tract (33.18%), the nasal cavity (28.14%) and the vagina with the uterus (23.91%). There is the proportion of patients suffering of SB from ENT organs is 28.52% in structure of Moscow city Emergency Medical Service. There are the proportion of epistaxis 98.65%, ear bleeding - 0.89%, throat bleeding - 0.46% in structure of SB from ENT organs. We analyzed, that spontaneous epistaxis most frequent between October and April. This period characterized with 70.6% EMT calls from the total EMT calls to patients with SE.

Objective: The article presents an analysis of pre-hospital diagnosis of stroke in children., Material and Methods: Pediatric Stroke Center of Morozov Children's City Clinical Hospital (Center) for the period from October 2018 to December 2019, 502 cases of hospitalization of children by the First aid Station to the Center with directing diagnoses of ischemic stroke (IS), haemorrhagic stroke (HS), transient ischemic attack (TIA), vertebrobasilar syndrome (VBS) were analysed., Results and Conclusion: TIA was the most prevalent diagnosis made by the First aid station, with the lowest rate of confirmation after further examination in the hospital (7.8%). The higher rates of confirmation were observed for VBS (31.5%), IS (11.2%) and HI (9.1%). The so-called «masks of stroke» were diagnosed in 84.3% cases of hospitalizations that was in line with earlier studies, which reported 50 to 93%. Based on the data on the frequency of symptoms, their combinations and specificity, a screening scale for pre-hospital diagnosis of stroke in children was suggested.

The article describes statistical data on patients with angioedema (AE) in the structure of ambulance services and four large multidisciplinary hospitals with otorhinolaryngological departments of the city of Moscow for 2017. The ratio of the number of calls to the NSR in Moscow for AE to the total number of calls was analyzed; the ratio of the number of calls to the ambulatory system for AE to the total number of calls to patients with allergic reactions; the ratio of patients with AE among the total number of treated patients in 3 hospitals in Moscow; the ratio of patients with AE of the upper respiratory tract (URT) among the total number of patients with AE; the ratio of patients with AE URT among the total number of patients with ENT pathology. As a result of the study, it was found that the share of AE in the structure of emergency calls of ambulance teams ( n =3 070 491) was 0.7% ( n =20 040) and 38.4% of the total number of calls for allergic reactions ( n =giant urticaria 52 153). Patients with AE make up 0.34% ( n =919) of the total number of treated patients in hospitals ( n =269 980). The proportion of patients in whom AE was manifested with a lesion of URT among patients with AE is 1 1.5%. The frequency of occurrence of AE URT among patients hospitalized with pathology of ENT organs ( n =14 395) is 0.7% ( n =106).

Aim of the study was to analyze causes of pulmonary artery thromboembolism (PATE) hypodiagnostics at prehospital stage. We compared clinical and electrocardiographic picture of acute period of the disease in groups of patients with diagnosed (n=61) and undiagnosed (n=22) PATE at prehospital stage. We also assessed retrospectively probability of PATE according to Revised Geneva Score. In 49 cases we analyzed dynamics of the acute period of PATE. The analysis showed that in more than 50% of cases hypodiagnostics of PATE was caused by similarity of observed clinical and electrocardiographical picture and that of acute coronary syndrome. There were no differences between groups in Revised Geneva Score.

Perfusion computed tomography (CT) allows to evaluate brain perfusion and provides additional information about local cerebral hemodynamics in stroke patients. Twenty-seven patients underwent CT-perfusion in the early acute phase of ischemic stroke. Significant differences between ischemic lesion and contralateral hemisphere on CBF and MTT scans during the first 3 hours after stroke were revealed. In the following 24 h, the differences were seen in all perfusion parameters. CT-perfusion allows to reveal perfusion parameters associated with stroke severity and outcome that is relevant for prescription of reperfusion treatment beyond the boundaries of 3-4.5h "therapeutic window".

Clinicostatistical analysis of arterial hypertension complicated with hypertensive crisis using data of Moscow A.S.Puchkov Station of Urgent and Emergent Medical Aid revealed 14% rise in number of hypertensive crises during the period from 2005 to 2009. Number of hypertensive crises increased among persons of young age (18-35 years). Frequency of cerebrovascular complications of hypertensive crises was age dependent with maximal values among men aged 36-74 years and women older than 75 years.

Butylaminohydroxypropoxyphenoxymethyl methyloxadiazole was used in prehospital treatment of 40 patients (15 women, 25 men aged 63+/-17.1 years) with complicated hypertensive crises (HC) characterized by acute involvement or high risk of progression of damage of internal organs. The drug was administered as intravenous bolus injection of 10-50 mg (1-5 ml of 1% solution) under control of arterial pressure (AP) and heart rate (HR). The patients noted alleviation of symptoms by 15th min and disappearance of main manifestations of HC by 30th min. Systolic and diastolic AP were significantly lowered from baseline 190.0+/-24.4 and 105.0+/-13.5 mm Hg to 153.3+/-20,1 and 85.0+/-12,6 mm Hg, respectively. Mean dynamics of lowering of systolic and diastolic AP was 19.5 and 19%, respectively. This was accompanied by 15.4% lowering of HR (from 90.3+/-12.0 to 76.4+/-9.4 bpm). Myocardial ischemia in those patients who had it diminished or disappeared. Thus in patients with complicated HC the study drug exerted effective antihypertensive and antiischemic actions. It was well tolerated and did not cause significant side effects.

Aim: To compare efficacy and tolerability of felodipine based antihypertensive therapy with those of standard hospital treatment of hypertension., Material: Inhospital patients were randomized 1:2 to standard antihypertensive therapy or to therapy which included felodipine (n=50 and 100, 36 and 35% men, mean age 66.0+/-8.4 and 64.3+/-8.1 years, initial blood pressure 162.4+/-9.3/99.3+/-6.4 and 163.2+/-10.3/98.2+/-6.5 mm Hg, respectively). Felodipine was used: (1) as first drug with subsequent addition of other drugs as required; (2) after cessation of previously ineffective therapy; (3) in cases of intolerance to previous therapy, (4) as supplementation to previously insufficiently effective therapy. Results. At discharge in felodipine group 6, 25, 29 and 40% of patients received mono- (felodipine 10 mg/day), 2, 3 and 4 component therapy, respectively. In standard treatment group all patients received combination therapy with 3 (48%) or 4 (52%) drugs. Felodipine group compared with group of standard therapy was characterized by less frequent correction of antihypertensive therapy (0.8+/-0.6 and 2.2+/-0.9, p<0.05), smaller number of drugs used (3.03+/-0.95 and 3.52+/-0.5, p<0.01), more frequently achievement of target blood pressure level (88 and 64%, p=0.0075), less pronounced difference between morning and evening self-measured blood pressure., Conclusion: The use of felodipine in hospitalized patients with hypertension allowed achieving target blood pressure with fewer drugs. Felodipine was safe and well tolerated.

Screening of chronic alcohol intoxication (CAI) based on parallel use of test-questionnaires (CAGE, PAS-questionnaire) and assessment of organic evidence of alcohol abuse were employed in a clinicoepidemiological case-control survey covering 1191 patients aged 16-91 years admitted to a general hospital. 3335 autopsy protocols were analysed by pathoanatomical and forensic-medical criteria of CAI. It was found that CAI, directly or indirectly, raises risk of a wide spectrum of internal diseases which, according to ICD-10, are not directly related to alcohol. Each 5th hospitalization was caused by CAI sequela. Combined use of tests-questionnaires and consideration of physical stigms of CAI are proposed for screening of alcohol abuse and latent alcoholism in general medical practice. The authors think it necessary to establish addictological service at large general hospitals.

The status of the dermatological and venereological service in Moscow is analyzed and the epidemic situation for syphilis described for the period of 1992-1996. The activities of the service are assessed and its prospects for the nearest future outlined.

Tuberculous infection is no longer controllable in Moscow. Tuberculosis ranks first in the structure of morbidity caused by monoinfections. The prevalence of tuberculosis is increasing both among adults and children. Increasing incidence of forms with bacterial release is especially dangerous. Such patients represent the greatest epidemic hazard for the population. In Moscow the situation with tuberculosis is characterized by a notable reservoir of infection among socially maladapted subjects. A special department for this patient population was created in tuberculosis hospital No. 11; besides medical care, the patients are rendered social care there. The situation with tuberculosis in Russia and in Moscow requires urgent measures aimed at stabilization of the epidemiological process.

Based on vast comprehensive medical statistical database, the authors analyze the health status of the population and the efficacy of public health service in Moscow. The pre-crisis tendencies and the modern status of public health under modern socioeconomic conditions are noted.