[The gender aspects of changes in mortality during COVID-19 pandemic as exemplified by Moscow].

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.

[Social deprivation of persons older than working age in terms of death causes which require forensic medical examination.]

The article analyzes structure of forensic medical research of persons older than working age and its change during period of improving social and economic situation in the country. Persons whose causes of death are determined by forensic medical examination are considered as a deviant group of people who did not adapt to changing socio-cultural conditions and to age changes. That was manifested in causes and circumstances of death (external causes, death at home without witnesses, death on street or in hospital without examination). The information on 72 324 forensic examinations of elderly residents in Nizhny Novgorod region for 2003-2017 was analyzed. It was done in terms of sex, living or not in the regional center and age groups (advanced: 60-74 years for men and 55-74 years for women, senile: 75-84 years, age of longevity: 85 years and older). It is shown that the size of the deviant group of retirees is increasing, and this increase is not a consequence only of the population aging. The contribution of loneliness to formation of the deviant group exceeds the contribution of socioeconomic disadvantages: no correlation was found between the frequency of forensic examinations and the mortality from causes related to alcohol; from 2003 to 2017, the share of external death causes and the proportion of corpses taken for examination from street are decreasing. The structure of external and somatic death causes of persons older than working age established during forensic medical research is determined by age, place of residence as well as social and economic situations in the region, changing for the period studied in direction of reducing differences.

Reserves for Reducing Mortality in Russia Due to the Efficiency of Health Care.

Approaches to assessing the role of health care in reducing mortality in Russia from the standpoint of controlling manageable causes are discussed. Based on the concept of avoidable mortality, trends in regional variability of mortality, the nosological and gender characteristics for the years 2000-2019 have been analyzed. The patterns revealed indicate the following: a significant contribution of medicine and health care to the decrease in the premature reduction in the life expectancy of the population, the expediency of developing a regional classification of the list of avoidable causes of mortality, and the decisive role of prevention and the improvement of the lifestyle of the population of young and middle ages in the past two decades against the background of a slow increase in the capacity of clinical medicine in the diagnostics and treatment of diseases.

[Cardinal problems of the regional bacteriological laboratories of tuberculosis facilities].

Restructuring the health care system and the epidemiological situation associated with tuberculosis result in an increased burden on the bacteriological laboratories (BLs) of tuberculosis facilities. At present, there are no statistical data that enable one to estimate the capacity of a laboratory service to assure the adequate quality and efficiency of bacteriological diagnosis. To assess the state of the headquarters BLs of tuberculosis facilities, the authors have worked out a questionnaire to glean necessary information on the activity of the laboratories to such an extent that suffices to reveal cardinal problems in the work of individual laboratories and the laboratory network as a whole. Out of the 48 questionnaires sent from the regional BLs, the data available from 22 laboratories that had fully answered all the questions were analyzed. The data obtained are referred to as of 2004, i.e. when the current antituberculous care projects were launched, which is of significance in organizing the monitoring of a laboratory service and in assessing the progress of the projects. The authors have identified the following cardinal problems: inadequate readiness of most laboratories to fully perform their incumbent functions; no coordination in providing data at the regional and federal levels; inefficient laboratory diagnosis that is associated with the disintegration of the curatorial institution, with neither reference relations no united external or internal quality control programs, with the lack of expertise and the undermanning of the laboratories, with the obsolete list of staff members and the obsolete standards for calculation of their loads, with the deterioration of a material and technical base, and with the unconformity of equipment to the state-of-the-art technologies. In order to solve the above problems, the authors offer a laboratory service monitoring system based on the proposed questionnaire, followed by the computerization of data collection and the compulsory supervision of regional laboratories by the officials of district and federal BLs.

New trends and clinical patterns of human trichinellosis in Russia at the beginning of the XXI century.

Official national statistics show a gradual decline in the incidence of trichinellosis in Russia from 971 cases in 1996 to 527 cases in 2002. Of the total 864 cases involved in 47 trichinellosis outbreaks during 1998--2002, only 35.8% were due to infected pork compared to 80% in 1995--1996. Other important sources were wild animals, such as bear (Ursus arctos) (39.5%), badger (Meles meles) (10.6%), and dog meat (11.9%). Children composed 15.9% of all cases. Overall, 81.0% of pork-cases occurred in the European part of the country, and 89.4% of bear-meat cases were from the Asian region where most of the badger and dog-meat cases also originated. The percent of clinically severe cases of disease derived from pork and from bear meat was 7.7% and 7.9%, respectively; the frequency of moderate cases from pork was significantly higher than from bear meat. Clinically severe cases from badger and dog meat were 1.1% and 1.9%, respectively, where the number of clinically moderate cases from badger meat was significantly larger than that from dog meat. A disturbing trend is the 52.3% of trichinellosis cases during 1998--2002 in Russia that were derived from wild animal meat, especially the clinically severe cases occurring among the aboriginal Siberian population. The contributing factors to the slow decline in trichinellosis incidence in Russia and to the increase in percentage of cases originating from wild animal meat are the distribution and consumption of veterinary-uncontrolled pork, poaching and distribution of wild animal meat, and the neglect of medical and civil regulations. These trends should be seriously evaluated by the institutions of health, education, and by the veterinary service.

[The mathematical modelling of tropical malaria]. / Matematicheskoe modelirovanie tropicheskoi maliarii.

The new mathematical model of P. falciparum malaria has been created. One means the operational forecast of epidemic process when different control measures are realized. The original modelling methodology for epidemics is used. The proposed methodology is allowed to take into account the natural variety of model's parameters. The malaria model consists of the nonlinear integro-differential in partial derivatives combined equations including individual and population characteristics. The informatics technologies permits to see information about model and its grounds. The model's verification has been done on data of Garki-project.

[Imported cases of malaria and HIV infection in Russia]. / Rasprostranenie zavoznykh sluchaev malarii i VICH-infektsii v Rossii.

Malaria does not belong to a group of diseases that are markers of HIV infection; a combined transmission of malaria and HIV infection does not occur (except for cases of vertical and syringe-associated transmission of causative organisms), but HIV infection is more common in the malaria-endemic areas since both diseases are socially related. Expansion of both infections is associated with the same social processes in society. This paper analyzes the relationship of the spread of HIV-infection to the routes of migration of narcotic agents in case of Russia, by comparing the spread of HIV infection with the regional distribution of cases of malaria imported by Tadjikistan inhabitants. Importation of malaria from other CIS countries was compared as a control. The authors estimated the coefficients of correlation between the affliction of Russia's population with HIV infection and the rate of malaria importation from Tadjikistan (0.733) and other CIS countries (0.496), as well as between the importation of malaria to Russia and the total volume of a migratory flow from Tadjikistan in the period of 1992 to 2001 (-0.931). The findings indirectly support the assumption that there is a relationship of malaria importation from Tadjikistan to illegal migration, which suggests that the intensive importation of malaria from Tadjikistan may serve as a marker of importation of injectable narcotic drugs and hence that the spread of HIV infection in Russia may be intensified. The authors again emphasize that prevention of the spread of socially related infections requires that the whole society should combine efforts since public health care should not be a hostage of social problems.

[The malariological zoning of the Guyana portion of the nosogeographical range of malaria based on cluster analysis]. / Maliariologicheskoe raionirovanie gaianskogo uchastka nozoreala maliarii na osnove klasternogo analiza.

Cluster analysis of malaria incidence in Guyana revealed a relationship between population migration intensity and increased rate of P falciparum infection. Such a relationship was not detected for P. vivax malaria. Seasonal differences in malaria incidence are explained by changes in vector ratio. Malariogenic stratification helped clear out the role of three main malaria vectors in different regions of Guyana.

[Phenotypic variability in P. vivax with short- and long-term incubation period]. / Fenotipicheskaia izmenchivost' P. vivax s korotkoi i dlitel'noi inkubatsiiei.

The combined transmission of P. vivax phenotypes was studied. The phenotypes were determined by the duration of a latent parasitic development stage by comparing the intervals from first manifestations of malaria with short- and long-term incubations to its relapse. The study used data on 2493 patients treated with chloroquine (900 mg base for adults) alone at follow-ups in the North-Eastern Delhi (India) in 1988-1992. The combined transmission of P. vivax phenotypes was shown to differ in malaria with short- and long-term incubation. The P. vivax phenotype with manifestations on an average a year following infection in patients with mainly short-term incubation malaria and that with manifestations on an average year and a half after infection in a group of patients with primary long-term incubation malaria were significantly more frequently. Long-term incubation malaria shows simultaneously a larger number of phenotypes than does short-term incubation one. Patients with long-term incubation malaria display a combination of 2 phenotypes (6%) significantly less frequently than that of 3 different phenotypes or more (17%). The similar combinations were observed in the equal number of patients with short-term incubation malaria (7%).

[Clonorchiasis in the People's Republic of Vietnam. 2. The clinico-parasitological examination of a focus and a trial of prazinquantel treatment]. / Klonorkhoz v SRV. Soobshchenie 2. Kliniko-parazitologicheskoe obsledovanie ochaga i opyt lecheniia prazikvantelem.

Examinations of 1599 residents of a polyinvasion focus at a seaside province Ha Nam Nin, Vietnam, have revealed clonorchiasis in approximately 13.9% of the examinees; in subjects aged over 30 this value was 29.3%. Factors conducive to a lower incidence of clonorchiasis were detected, among them a moderate intensity of the invasion: the mean arithmetic was 1419 +/- 306 eggs/g, the mean geometric 673 egg/g, as shown by the Kato-Kats' technique. Analysis of five therapeutic schemes used in clonorchiasis, making use of chloxilin, medamin or praziquantel, has demonstrated a low efficacy of all of them. Praziquantel therapy in a daily dose of 25 mg/kg for 2 days was found the most effective (52%), being conducive to a reduction of the invasion intensity by at least 90%. Such therapy was associated with a high incidence of side effects (91.2%), this ruling out a higher dosage.

[An evaluation of the spectrum of Plasmodium vivax subpopulations by the results of an experimental study of late relapses in Delhi]. / Otsenka spektra subpopuliatsii Plasmodium vivax po rezul'tatam éksperimental'nogo izucheniia otdalennykh retsidivov v Deli.

The spectrum of Plasmodium vivax subpopulations could be evaluated by analyzing the results of experimental studies of late relapses in P. vivax malaria in north-western Delhi. The spectra of the subpopulations causing late recurrences were different for malaria with short-and longterm incubations. The conclusions previously made by mathematical stimulation as to that malaria with longterm incubation is mainly transmitted at the beginning of the season have been confirmed. Based on the results of the frequency analysis, 6 P. vivax subpopulations with the values of their development duration of 15, 240, 300, 390, 720, and 1020 days, respectively, were identified for formalization of an epidemic process.

[The modulation of Plasmodium falciparum virulence as a factor in the self-regulation of the malarial parasitic system]. / Moduliatsiia virulentnosti Plasmodium falciparum kak faktor samoreguliatsii parazitarnoi sistemy maliarii.

Higher Plasmodium falciparum virulence is one of the major factors that contributes to the development of severe malaria and leads to death. However, the nature of virulence and its time course are not so far fully understood. The authors have made a published data-based hypothesis that the virulence of P. falciparum strains circulating in the malaria endemic areas of tropical Africa is not strictly genetically determined. The virulence of P. falciparum increases with its passage through the non-immune organisms of the infected persons. This mechanism of virulence modulation ensures the survival of the parasite in the human population with a considerable communal immunity. To test the validity of the hypothesis, the authors have used a mathematical analytical method to assess the published data on malaria mortality in some areas of tropical Africa. The results of the analysis have shown close values of actual and expected data.

[The first trial of azinox treatment in a clonorchiasis focus in the Socialist Republic of Vietnam]. / Pervyi opyt lecheniia azinoksom v ochage klonorkhoza v SRV.

Trials of biltricide (Merck, India) and azinox, its analog manufactured in this country, carried out in a mixed focus of clonorchiasis and intestinal nematodiases in Vietnam, have not shown any noticeable difference in the efficacy and tolerance of these drugs, that were administered for 3 days in total doses of 60 and 75 mg/kg. The mean efficacy of clonorchiasis therapy was 59.2%, and the invasion intensity reduced by more than 98%. Slight side effects were observed in 86.7% of patients.

[The reaction of taiga ticks to an attractant. II. The rates of removing ticks from a population]. / Reaktsiia taezhnykh kleshchei na attraktant. Soobshchenie II. Tempy iz''iatiia kleshchei iz populiatsii.

Catching ticks on the attractant-moistened napkins and on the flag (control) under field conditions during 5 days has demonstrated that a population of taiga ticks on the treated areas can be killed within 1-2 weeks when attractive-acaricidal granules are applied.

[Clinico-parasitological research in a focus of intestinal nematodiasis in Habak Province (the Socialist Republic of Vietnam) and the efficacy of medamine treatment in these infestations]. / Kliniko-parazitologicheskie issledovaniia v ochage kishechnykh nematodozov v provintsii Khabak (SRV) i éffektivnost' lecheniia medaminom pri étikh invaziiakh.

The authors described the focus of intestinal nematodiasis in Vietnam with the rate of infestation on the average 74.6% for ascaridiasis, 30.8 for trichocephaliasis and 20.2% for ancylostomiasis. The high rate of the geohelminthic infestation was related with the use of untreated feces for the vegetables rearing. The clinical symptoms of intestinal nematodiasis were featured by dyspepsia, pain and asthenoneurotic syndromes. The first field trials of mediamine treatment were performed for 267 patients in the high-intense foci of intestinal nematodiasis in the tropics. In trichocephaliasis patients therapeutic efficacy of the drug was 74%, in ancylostomiasis patients it was 71.9, in ascaridiasis patients 68.4%. Retrograde ascarid migration was noted in two patients.

[The dynamic activity of lymphocyte succinate dehydrogenase and its correlations in experimental malaria]. / Dinamika aktivnosti suktsinatdegidrogenazy limfotsitov i ee korreliatsionnykh sviazei pri éksperimental'noi maliarii.

Succinic dehydrogenase (SDH) activity in peripheral blood lymphocytes has been studied in progressing experimental malaria on a P. yoelii model, the strain 265 BY; the multinipple rats Mastomys natalensis. Cytochemical method employing n-nitrotetrazolium violet was used. Comparative analysis of changes in SDG activity in peripheral blood lymphocytes and changes in the level of parasitemia has demonstrated that day 10 was a critical period when there was an evident inverse correlation between the qualitative parameters. The findings give evidence of SDH participation in an adequate response of immunocompetent cells to malaria infection, thus leading to recovery.

[The clinico-epidemiological characteristics of opisthorchiasis foci in the Yamalo-Nenets Autonomous Okrug and the treatment results with praziquantel]. / Kliniko-épidemiologicheskaia kharakteristika ochagov opistorkhoza v Iamalo-Nenetskom avtonomnom okruge i rezul'taty lecheniia prazikvantelem.

A clinical and epidemiological study of opisthorchiasis foci in the Yamalo-Nenets Autonomous Okrug was carried out. 764 people were surveyed, including 473 aborigines of the north, 207 denizens, and 84 migrants. Opisthorchiasis infection rate in villages was 40.5-45.7%. The intensity of infection was lower than 200 eggs per g faeces. The modelling of opisthorchiasis prevalence performed after Muench showed the highest correlation with the "simple" and "reversible" models. Factors determining the infection spread and limiting its intensity and those influencing the effect of chemotherapy were defined. Theoretically determined radical suppressive low-dose praziquantel chemotherapy was carried out. The efficacy of the drug, 25, 30, 40 and 50 mg/kg, varied from 76.5 to 92.0% (mean 88.1%), and the decrease of the egg density was more than 60%. The incidence of side effects of the therapy averaged 45.3%.

[Interferon status and the HLA antigen system. 1. Unilocular echinococcosis]. / Interferonovyi status i antigeny sistemy HLA. 1. Odnokamernyi ékhinokokkoz.

In 26 patients with hydatid disease interferons (IFN) blood levels by titration method and HLA-antigens by lymphocyte cytotoxicity microtest were estimated. In total group B5 antigen frequency was significantly (p = 0.007 after Fischer) higher than in the control group of 155 practically healthy persons: 38.5% and 14.7% respectively. The determination of possible correlation between IFN-alpha and IFN-gamma production, HLA-antigens specificity and the localisation of Echinococcus granulosus cysts showed that in hydatid disease A2 and B5 antigens carriers are significantly stronger producers of the cytokines as compared with patients having A3 and B13 antigens. The highest titers of IFN-alpha was found in A2 antigen carriers with the liver cysts, the highest level of IFN-gamma had B5 antigen carriers with the lung damage. A3 and B13 antigens carriers had low IFN titers independently of the character of damaged organ. Relatively high IFN-gamma blood titers in B5 antigen carriers with the lung cysts, persons predisposed to hydatid disease, permit supposing the stimulation of the cytokine production by the parasite for cysts formation in the lungs.

[Sanitary and helminthic characteristics of soil]. / Sanitarno-gelmintologicheskaia kharakteristika pochvy.

Soil of 20% of economic districts of Russian Federation is slightly polluted by helminths (10 eggs per kg of soil), 64% is moderately polluted (11-100 eggs per kg), 16% much polluted (more 100 eggs per kg). Soil of agricultural fields is polluted 2-3 times more because of use of sewage and their sediments. Recommendations on protection of soil from pollution by helminths are given.

[The initial experience with embovin treatment in a a focus of intestinal nematode infections in the Socialist Republic of Vietnam]. / Pervyi opyt lecheniia émbovinom v ochage kishechnykh nematodozov v SRV.

Comparative trials of pirantel analogs--combatrin (Pfizer, Philippines) and embovin (Russia) were carried out in a hyperendemic focus of intestinal nematodoses in Vietnam. The drugs were prescribed in a single dose of 10 mg/kg. No significant differences in the efficacies of the drugs were revealed: combatrin and embovin efficacies in ascariasis were 94.3 and 98.0%, respectively (p > 0.05), in ankylostomiasis 76.3 and 58.3%, respectively (p > 0.05).