Event rates and incidence of post-COVID-19 condition in hospitalised SARS-CoV-2 positive children and young people and controls across different pandemic waves: exposure-stratified prospective cohort study in Moscow (StopCOVID).

BACKGROUND: Long-term health outcomes in children and young people (CYP) after COVID-19 infection are not well understood and studies with control groups exposed to other infections are lacking. This study aimed to investigate the incidence of post-COVID-19 condition (PCC) and incomplete recovery in CYP after hospital discharge and compare outcomes between different SARS-CoV-2 variants and non-SARS-CoV-2 infections. METHODS: A prospective exposure-stratified cohort study of individuals under 18 years old in Moscow, Russia. Exposed cohorts were paediatric patients admitted with laboratory-confirmed COVID-19 infection between April 2 and December 11, 2020 (Wuhan variant cohort) and between January 12 and February 19, 2022 (Omicron variant cohort). CYP admitted with respiratory and intestinal infections, but negative lateral flow rapid diagnostic test and PCR-test results for SARS-CoV-2, between January 12 and February 19, 2022, served as unexposed reference cohort. Comparison between the 'exposed cohorts' and 'reference cohort' was conducted using 1:1 matching by age and sex. Follow-up data were collected via telephone interviews with parents, utilising the long COVID paediatric protocol and survey developed by the International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC). The WHO case definition was used to categorise PCC. RESULTS: Of 2595 CYP with confirmed COVID-19, 1707 (65.7%) participated in follow-up interviews, with 1183/1707 (69%) included in the final 'matched' analysis. The median follow-up time post-discharge was 6.7 months. The incidence of PCC was significantly higher in the Wuhan variant cohort (89.7 cases per 1000 person-months, 95% CI 64.3-120.3) compared to post-infection sequalae in the reference cohort (12.2 cases per 1000 person-months, 95% CI 4.9-21.9), whereas the difference with the Omicron variant cohort and reference cohort was not significant. The Wuhan cohort had higher incidence rates of dermatological, fatigue, gastrointestinal, sensory, and sleep manifestations, as well as behavioural and emotional problems than the reference cohort. The only significant difference between Omicron variant cohort and reference cohort was decreased school attendance. When comparing the Wuhan and Omicron variant cohorts, higher incidence of PCC and event rates of fatigue, decreased physical activity, and deterioration of relationships was observed. The rate of incomplete recovery was also significantly higher in the Wuhan variant cohort than in both the reference and the Omicron variant cohorts. CONCLUSIONS: Wuhan variant exhibited a propensity for inducing a broad spectrum of physical symptoms and emotional behavioural changes, suggesting a pronounced impact on long-term health outcomes. Conversely, the Omicron variant resulted in fewer post-infection effects no different from common seasonal viral illnesses. This may mean that the Omicron variant and subsequent variants might not lead to the same level of long-term health consequences as earlier variants.

HIV knowledge, self-perception of HIV risk, and sexual risk behaviors among male Tajik labor migrants who inject drugs in Moscow.

BACKGROUND: The interplay of human immunodeficiency virus (HIV) knowledge and self-perception of risk for HIV among people who inject drugs is complex and understudied, especially among temporary migrant workers who inject drugs (MWID) while in a host country. In Russia, Tajik migrants make up the largest proportion of Moscow's foreign labor. Yet, HIV knowledge and self-perceived risk in association with sexual risk behavior among male Tajik MWID in Moscow remains unknown. OBJECTIVE: This research examines knowledge about HIV transmission, self-perception of HIV risk, and key psychosocial factors that possibly contribute to sexual risk behaviors among male Tajik labor MWID living in Moscow. METHODS: Structured interviews were conducted with 420 male Tajik labor MWID. Modified Poisson regression models investigated possible associations between major risk factors and HIV sexual risk behavior. RESULTS: Of the 420 MWID, 255 men (61%) reported sexual activity in the last 30 days. Level of HIV knowledge was not associated in either direction with condom use or risky sexual partnering, as measured by sex with multiple partners or female sex workers (FSW). Lower self-perceived HIV risk was associated with a greater likelihood of sex with multiple partners (aPR: 1.79, 95% CI: 1.34, 2.40) and FSW (aPR: 1.28, 95% CI: 1.04, 1.59), but was not associated with condom use. Police-enacted stigma was associated with sex with multiple partners (aPR: 1.22, 95% CI: 1.01, 1.49) and FSW (aPR: 1.32, 95% CI: 1.13, 1.54). While depression and lower levels of loneliness were associated with condomless sex (aPR: 1.14, 95% CI: 1.05, 1.24; aPR: 0.79, 95% CI: 0.68, 0.92, respectively), only depression was associated with condomless sex with FSW (aPR: 1.26, 95% CI: 1.03, 1.54). CONCLUSIONS: HIV prevention programing for male Tajik MWID must go beyond solely educating about factors associated with HIV transmission to include increased awareness of personal risk based on engaging in these behaviors. Additionally, psychological services to counter depression and police-enacted stigma are needed.

Causes of Death in Patients Asking for Polyclinic Care for Coronary Heart Disease.

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 outstanding Russian ophthalmologist Alexey Nikolaevich Maklakov]. / Vydayushchiisya russkii oftal'molog Aleksei Nikolaevich Maklakov.

The conducted archival research and analysis of literary publications allowed us to supplement the biography and creative path in science, clinical and social activities of the outstanding Russian ophthalmologist A.N. Maklakov. This article emphasizes the urgency of the problem of teaching in medical universities, and gives special attention to the thoughts of the scientist about providing clarity in the process of teaching students. The article notes his role in the arrangement and equipment of the new eye clinic of the Moscow University, and presents fragments of memoirs of his student and mentee, another famous Russian ophthalmologist S.S. Golovin. A remark is made about the need to clarify the terms traditionally accepted in the history of medicine in relation to surgery and ophthalmology. An assessment is given on the contribution of A.N. Maklakov to the establishment of the Moscow Ophthalmological Circle, his efforts to unite doctors, and the development of the statutory documents of the All-Russian Society of Eye Doctors.

[On becoming of nephrology in the USSR: The role of Moscow therapists M. I. Vihert and E. M. Tareev].

The article considers stages of becoming of Soviet nephrology as independent scientific educational clinical discipline. The role of M. I. Vikhert in becoming of nephrology as independent clinical direction within the framework of the clinic of internal diseases is demonstrated. Also the role of E. M. Tareev as the founder of nephrology in the USSR as institutionalized clinical discipline is revealed.

[Touches to the portrait of I.M. Kovarsky]. / Shtrikhi k portretu I.M. Kovarskogo.

Ilya Matveyevich Kovarsky (1856-1933) - the founder and permanent head of the First Moscow Dentistry School, organizer and honorary member of the Moscow Dentistry Society, editor and publisher of one of the first Russian dental journals «Odontological Revue¼ - was deprived of his personal pension and suffrage in 1930 as a former owner of a private capitalist enterprise; his name was actually erased from the national dentistry. The portrait of Ilya Matveyevich Kovarsky - a remarkable doctor, teacher and worthy man - is reconstructed by the documents preserved in the Kovarsky family archive (on the basis of which this article was written) and the memories of his eldest daughter (published for the first time).

[From the history of domestic dentistry: Moscow Dental School of the Privat-docent of Moscow University, MD Gilyariy Ivanovich Vilga]. / Iz istorii otechestvennoi stomatologii: Moskovskaya zubovrachebnaya shkola privat-dotsenta Moskovskogo universiteta doktora meditsiny Gilyariya Ivanovicha Vil'ga.

Based on archival data, the authors describe the Moscow School of Dentistry with dental courses for doctors, dentists, and dentists of the Moscow University, Privat-docent Dr. Gilyari Ivanovich Vilga, examine the background to its formation, provide unique archival data on the location of the school, as well as its internal organization and equipment. The authors review in detail the program of courses, as well as their duration, cost, and form of student accountability. During its existence (1909-1918), more than two thousand dentists were educated at G.I. Vilg's school, among them Alexander Ivanovich Evdokimov, a future corresponding member of the USSR Academy of Medical Sciences, director of the State Institute of Dentistry (GIZ) and the State Institute of Dentistry and Odontology (GIZO). The authors of the article also focus on analyzing the differences in the approaches to the organization of several dental schools, viz: The First Moscow I.M. Kovarsky School of Dentistry and the Second G.I. Vilga School of Dentistry. In his efforts, I.M. Kovarskij's aspirations to establish the best dental school in Russia were crowned with success: a specially constructed and equipped building meeting the state-of-the-art requirements (the building even boasted an X-ray machine), and the best professors and instructors of the University of Moscow of that time were hired. In contrast, G.I. Vilga rented premises for his school, the equipment was in short supply, and he himself was the only eminent professor. Nevertheless, his fierce desire to unite the entire dental community and organize the best dental care for the entire population of Russia allowed his brainchild to enter the top five schools of the time.

[Dependence of medical rehabilitation effectiveness of patients with somatic diseases and meteopathology on features of weather-forming factors of the Moscow region]. / Zavisimost' effektivnosti meditsinskoi reabilitatsii patsientov s somaticheskimi zabolevaniyami i meteopatologiei ot osobennostei pogodoobrazuyushchikh faktorov Moskovskogo regiona.

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/osteoarthritis¼ 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, «dry¼ carbon dioxide baths, applications with brine on the affected joints and RE (2nd group); AMF, «dry¼ 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, «dry¼ 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.

[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.

[The possibilities and advantages of conducting multicenter clinical trials on the basis of outpatient clinics in Moscow].

The article presents the special role of the outpatient unit (urban polyclinics) in the system of urban medical organizations, which has significant development potential in the field of clinical research. This activity became possible due to the systematic work on equipping outpatient clinics with the most modern diagnostic equipment, the availability of specialists trained in the organization and conduct of clinical trials according to the international rules of good clinical practice. A special value lies in the fact that the polyclinic network has an extensive database that includes millions of patients and provides the opportunity to perform the highest level of medical expertise and research.

On the Commentary by Anatoly I. Mikhalsky Published in Biochemistry (Moscow), Vol. 88, No. 1, pp. 162-163 (2023).

Caution is needed in using cohort data when studying age-related mortality dynamics, because mortality depends not only on age, but also on the changing living conditions over time. A hypothesis is proposed for further testing that the actuarial aging rate may even decrease in more recent birth cohorts of people due to improved living conditions.

On the Paper by Leonid A. Gavrilov and Natalia S. Gavrilova entitled "Trends in Human Species-Specific Lifespan and Actuarial Aging Rate" Published in Biochemistry (Moscow), Vol. 87, Nos. 12-13, pp. 1622-1633 (2022).

The methodology used for analyzing the survival process should keep in mind heterogeneity in empirical data. Cross-sectional data are more heterogeneous in comparison with birth-cohort data.

Evolutionary Dynamics of Avian Influenza Viruses Isolated from Wild Birds in Moscow.

Forty-five strains of AIVs were isolated from wild aquatic birds during their autumn migration through Moscow (Russia). The aim of this work is to study the dynamics of AIV genomes in their natural habitat. Viruses were isolated from fecal sample in embryonated chicken eggs; their complete genomes were sequenced, and a phylogenetic analysis was performed. The gene segments of the same lineage persisted over the years in the absence of persistence of complete viral genomes. The genes for internal proteins of the same lineage were often maintained by the viruses over few years; however, they were typically associated with the genes of novel HA and NA subtypes. Although frequent reassortment events were observed for any pair of internal genes, there was no reassortment between HA and NA segments. The differences in the persistence of phylogenetic lineages of surface and internal proteins and the different evolutionary strategy for these two types of genes of AIVs in primary hosts are discussed.

Anthropogenic factors affecting the Moskva River water quality: levels and sources of nutrients and potentially toxic elements in Moscow metropolitan area.

This study aims to identify the main patterns of distribution and sources of pollutants in the Moskva River and their influence on river water quality under different levels of anthropogenic stress caused by the largest megacity in Europe - Moscow. For this study, we determined concentrations of 18 trace elements, nutrient elements and major ions, chemical and biochemical oxygen demand, and physical parameters of water at 45 stations on the Moskva River and 20 stations on its tributaries during spring flood and low water of 2019 and 2020 to identify the extent and mechanisms of urban impact on its water chemistry. Chemical elements concentrations have been determined using ICP-MS and ICP-AES methods. Mn, Al, Cu, Sr, Zn, B, Mo, and inorganic nitrogen were outlined as key pollutants according to various drinking water and environmental guidelines. Using correlation and factor analysis, five groups of elements were identified, corresponding to different drivers controlling their unequal distribution within the watershed: mineral sources (Sr, Li, B, Mo, Ca), sewage and road runoff (TN, TP, Sb, Ni, N-NO2, BOD5, COD, V, Zn), impact of acidic wetlands (Al, COD, Zr, Bi), groundwater and landfills leachate (V, As, Pb, U, Sb), and industrial activities (Zn, Cu). Water quality in the Moskva Basin on the whole is good according to the CCME Water Quality Index. Local deterioration of water quality to marginal and even fair (depending on the reference water quality guideline) is confined to the Moskva River part downstream from the Kuryanovo aeration station to the Moskva mouth and to the mouths of several heavily contaminated tributaries.

Benzo[a]pyrene in Moscow road dust: pollution levels and health risks.

Benzo[a]pyrene (BaP) is one of the priority pollutants in the urban environment. For the first time, the accumulation of BaP in road dust on different types of Moscow roads has been determined. The average BaP content in road dust is 0.26 mg/kg, which is 53 times higher than the BaP content in the background topsoils (Umbric Albeluvisols) of the Moscow Meshchera lowland, 50 km east of the city. The most polluted territories are large roads (0.29 mg/kg, excess of the maximum permissible concentration (MPC) in soils by 14 times) and parking lots in the courtyards (0.37 mg/kg, MPC excess by 19 times). In the city center, the BaP content in the dust of courtyards reaches 1.02 mg/kg (MPC excess by 51 times). The accumulation of BaP depends on the parameters of street canyons formed by buildings along the roads: in short canyons (< 500 m), the content of BaP reaches maximum. Relatively wide canyons accumulate BaP 1.6 times more actively than narrow canyons. The BaP accumulation in road dust significantly increases on the Third Ring Road (TRR), highways, medium and small roads with an average height of the canyon > 20 m. Public health risks from exposure to BaP-contaminated road dust particles were assessed using the US EPA methodology. The main BaP exposure pathway is oral via ingestion (> 90% of the total BaP intake). The carcinogenic risk for adults is the highest in courtyard areas in the south, southwest, northwest, and center of Moscow. The minimum carcinogenic risk is characteristic of the highways and TRR with predominance of nonstop traffic.

Elemental composition of atmospheric PM10 during COVID-19 lockdown and recovery periods in Moscow (April-July 2020).

Changes in the concentrations of PM10-bound potentially toxic elements (PTEs) during the COVID-19 lockdown period and after the revocation of restrictions were analyzed using the data received at the Aerosol Complex of Moscow State University in April-July 2020. During the lockdown, the input of biomass combustion products enriched in PTEs from the Moscow region hindered the decrease in pollutant concentrations. After the introduction of the self-isolation regime, lower concentrations of most PTEs occurred due to the decrease in anthropogenic activity and the rainy meteorological conditions. After the revocation of restrictive measures, the PTE concentrations began to increase. Multivariate statistical analysis (APCA-MLR) identified the main sources of atmospheric pollutants as urban dust, non-exhaust traffic emissions, and combustion and exhaust traffic emissions. PM10 particles were significantly enriched with Sb, Cd, Sn, Bi, S, Pb, Cu, Mo, and Zn. The total non-carcinogenic and carcinogenic risks, calculated according to the U.S. EPA model, decreased by 24% and 23% during the lockdown; after the removal of restrictions, they increased by 61% and 72%, respectively. The study provides insight into the PTE concentrations and their main sources at different levels of anthropogenic impact.

Active moss biomonitoring of airborne potentially toxic elements in recreational areas of Moscow.

Active biomonitoring using the moss bag technique was applied to examine the atmospheric deposition of potentially toxic and other elements in recreational areas of Moscow. Moss bags with Sphagnum girgensohnii were placed in the territory of seven parks (Losiny Ostrov, Victory Park, Ostankino, Sokolniki, Izmailovo, Kuzminki-Lyublino, Tsaritsyno) at three locations in each park from June to September 2018. The content of 32 chemical elements: Na, Mg, Al, Cl, K, Ca, Sc, V, Mn, Fe, Co, Zn, As, Br, Rb, Sr, Mo, Sb, Cs, Ba, La, Sm, Tb, Hf, Ta, W, Au, Th, U, Cu, Pb, and Cd in moss samples was determined by instrumental neutron activation analysis and atomic absorption spectrometry. After a 3-month exposure period, high uptake of Sb, U, Th, Sm, La, Mo, Zn, Co, Fe, V, Sc, etc. was observed in some of the moss samples. The physiologically active elements Cl and K and alkaline elements Rb and Cs were depleted from the moss tissue during the exposure. The high accumulation of Zn, Pb, Cu, Co, V, and Sb in moss samples evidenced an anthropogenic impact on the parks, mainly associated with road traffic. To determine the level of pollution, a set of environmental indices was calculated: contamination factor (CF), enrichment factor (EF), total pollution index (TPI), and relative accumulation factor (RAF). The highest RAF values were obtained for Sb on the territory of all parks. According to EF, the samples were enriched in Al, Fe, U, Pb, Cd, Au, Sb, Th, and Ta. High CF values were obtained for sites in Losiny Ostrov, Izmailovo, Tsaritsyno, and Kuzminki-Lyublino located close to roads. According to TPI, the level of air pollution on the territory of the abovementioned parks varied from moderate to high. To identify the major sources of pollution, correlation analysis and principal component analysis were applied.

[Abstracts of the National Congress with International Participation "Heart Failure 2022" Moscow, 09.12.2022 - 10.12.2022].

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[Professor Dmitry Egorovich Min - physician and poet]. / Professor Dmitrii Egorovich Min ­ medik i poet.

Dmitry Egorovich Min is an outstanding pathologist, forensic physician and hygienist of the Russian Empire, a prominent public figure, professor and vice-rector of the Imperial Moscow University, an outstanding poet-translator and one of the founders of the Russian school of forensic medicine. This article discusses the biography of D.E. Min, his merits and accomplishments in labor and creative activity.

[Causes of death in the Moscow region according to medical death certificates]. / Prichiny smerti v Moskovskoi oblasti po dannym meditsinskikh svidetel'stv o smerti.

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 6th 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 system¼ 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.