[Features of polymorbidity in cardiac and gastroenterologic patients from a therapeutic clinic].

AIM: To examine the incidence of polymorbidity (PM) and changes in its rates in 2003 to 2011 in cardiac and gastroenterologic patients living in the Novosibirsk Region and the Republic of Sakha (Yakutia) in accordance with gender, occupation, and residence. SUBJECTS AND METHODS: The dynamics of PM rates was analyzed in 13 496 patients who had been examined and treated at the Cardiology and Gastroenterology Departments, Therapeutic Clinic, Research Institute of Experimental and Clinical Medicine (Novosibirsk), 2003-2011. The study used an archival research method and a statistical analysis of all nosological entities, groups, and classes in ICD-10, regardless of whether the diagnosis was primary or concurrent. RESULTS: There was an increase in PM rates among the therapeutic clinic's patients of regardless of their gender and occupation. There were gender differences in the incidence of PM: its higher rates were noted in the women than those in the men among both the residents of the Novosibirsk Region and those of the Republic of Sakha (Yakutia). More significantly higher PM rates were registered in the male inhabitants of the Novosibirsk Region. There were also regional differences in the incidence of PM: its rates proved to be higher in the patients in the Republic of Sakha (Yakutia) than in those in the Novosibirsk Region in 2003-2007. At the same time, the growth rates for PM were more marked in the patients in the Novosibirsk region than in those in the Republic of Sakha (Yakutia); these differences levelled off in subsequent years. CONCLUSION: The findings indicate a pronounced increase in the incidence of PM in cardiac and gastroentorologic patients and determine a need to keep in mind the influence of gender, social, and regional factors on its development in order to create and improve a primary and secondary prevention, diagnosis and treatment system.

[Combination of arterial hypertension and type 2 diabetes mellitus with obesity].

The aim of the study was to elucidate dynamics of the incidence of arterial hypertension (AH), 2 type diabetes mellitus (DM), and obesity as the main risk factor of these conditions, combinations between them and certain circulation disorders in the patients admitted to our clinic from 2003 to 2011. We analysed 25,451 case histories. Patients were regarded as having AH, DM, obesity, coronary heart disease, cardiac rhythm disturbances and cerebovascular disorders if they had verified diagnosis of nosological forms corresponding to the respective ICD-10 codes. Their occurrence was calculatedfor 3 three-year periods with reference to the mean age of the patients in different groups. It was shown that increased incidence of AH in the above time periods was associated with the enhanced occurrence of combination of AH and obesity or AH, obesity and DM. Similarly, the increased incidence of DM was associated with the enhanced occurrence of combination DM, AH, and obesity. A significant increase of the mean age was documented only in women with AH and obesity and in men with AH or AH plus obesity. The presence of DM in AH patients had no appreciable effect on the frequency of cerebrovascular pathology that increased in the presence ofAH with obesity.

[Regional features of present-day polymorbidity of internal diseases].

Analysis of transnosological and trans-systemic polymorbidity for 2003-2011 in a general therapy clinic included 23310 patients (9111 men and 14199 women). It was supplemented by comparative analysis of morbidity in southern West Siberia and Yakutiya. The assessment was performed for three age groups (16-39, 40-59, over 60 years). The mean number of nosological forms (transnosological morbidity) and affected systems of organs (trans-systemic morbidity) averaged 5.19 +/- 0.01 and 4.09 +/- 0.01 per patient respectively (4.93 +/- 0.02 and 3.92 +/- 0.02 in men, 5.36 +/- 0.02 and 4.19 +/- 0.01 in women). The prevalence of polymorbidity was significantly higher in women than in men and in Yakutia higher than in West Siberia. The differences tend to be smoothed in recent years. Transnosological morbidity coefficients in male and female residents of Novosibirsk region increased from 4.14 +/- 0.03 and 4.60 +/- 0.04 respectively in 2003-2005 to 5.48 +/- 0.05 and 6.70 +/- 0.06 in 2009-2011 (p < 0.0001). In Yakutiya this growth in men was less pronounced than in a more temperate climate and was practically inapparent in women.

[The prevalence of metabolic syndrome in an organized population].

Triple screening of industrial employees (city of Mirny, West Yakutia) was carried out in 1991-2007 in conformity with the WHO/CINDI protocol designed to elucidate risk factors of chronic non-infectious diseases. The study included 2221 subjects. Metabolic syndrome (MS) was diagnosed based on criteria of NCEP-ATP III Program modified in 2005. The prevalence of MS increased during 17 years more than three-fold in both men and women (from 6 3 to 23.0% and from 9.2 to 32.4% respectively). In other words, it grows continuously. The commonest components in the structure of MS in men and women were arterial hypertension, abdominal obesity, hyperglycemia in 1991 and arterial hypertension, low HDLP cholesterol level, abdominal obesity in 2000 and 2007 (additionally, hypertriglyceridemia in men).

[The increase of carbon dyoxidi production at hypoxia in health subjects].

Pulmonary gas exchange, SpO2 and heart rate at 15-min hypoxia (respiration by air with 0.17; 0.15 and 0.13 oxygen fractions) have been investigated in 24 health subjects. It has been established, results of the group analysis and the results of the individual analysis had been differed. Reaction on hypoxia at the group analysis had been found only at 0.13 02 fraction. It was only hyperventilation. The individual analysis had revealed 4 types of reaction on hypoxia already at 0.17 and 0.15 02 fractions: (1) hyperventilation, (2) decrease of oxygen consumption, (3) increase of ventilation effectiveness, (4) increase of CO2 production. The mechanisms of last reaction are unknown, but we supposed it was connected with anaerobic metabolism. The reactions were detected at light hypoxia (0.17 and 0.15 oxygen fractions) in 90% health subjects when SpO2 decreased to 87-93%. The increase ventilation has been detected at hypoxia within respiration 0.13 oxygen in 60% subjects when SpO2 decreased to 83-87%, while other reactions were nearly absent.

Some pathophysiological regularities of formation of digestive diseases in population newly coming to the North.

OBJECTIVES: The purpose of the work was to reveal some pathophysiological regularities of digestive diseases (DD) development, depending on a period of living in the North. STUDY DESIGN: A total of 1,014 workers of industrial enterprises in Mirny-city (Yakutia) have been screened according to the WHO\ CINDI program. DD have been revealed in 321 patients. Dynamics of the clinical manifestations of DD has been analyzed depending on a period of living in the North with time intervals 0-5 years, 5-9 years, 10-29 years, 30 years and more. METHODS: There have been defined the content of cortisol, insulin, total cholesterol, triglycerides, alpha-cholesterol, neutrophils' activity on lysosomecation test with their percent distribution in blood serum. RESULTS AND CONCLUSION: It is stated that at digestive diseases, the hormonal-metabolic indices depend on a period of living in the North. The phase dynamics of changes of lipid, cortisol, insulin of cationic protein in blood neutrophils has been revealed. The data presented give more deep information about formation mechanisms of DD pathology.

[Complex evaluation of the impact of emerging mining industries in Northern regions on public health]. / Kompleksnaia otsenka vozdeistviia stroiashchikhsia gorno-obogatitel'nykh predpriiatii Severa na zdorov'e naseleniia.

The studies covered public health state in vicinity of concentration enterprise being built in Far North, with selecting a cohort of workers extracting diamonds in Yakutia, conducting a primary standardized health screening in accordance with WHO program. The public health state is characterized in connection with ecologic, social and economic circumstances. The authors necessitate complex evaluation of influence caused by industrial enterprises on health of workers and general population.

Problems of combined chronic pathology in newcomers of the north.

The problem of a combination of diseases is of great in the clinical treatment of internal diseases. Syntropy is of great significance to the northern population. A total of 617 patients living in Yakutia were studied. Analysing the combination of chronic pathology by means of the international classification of diseases was revealed that 7.4% of patients have only one nosological form and 55.1% had been diagnosed with 5 and more nosologies. When analysing the combination of the classes of the international classification of diseases it was seen that patients with one class constituted 14.0%. At same time the number of classes of the diagnosed pathology comprised 3 and more in 44.3% of the patients. In our opinion the process of long human adaptation to severe climatic conditions leads to a decrease of the functional reserves in an organism and disadaptation in newcomers. It leads to the development of severe chronic polynosological pathology, pathogenesis of which is defined by the for need complex of disadaptive disorder.