[The trends in primary morbidity of adult population of the Russian population during implementation of state programs].

The article presents the results of analysis of indices of primary morbidity of adult population in the Russian Federation during implementation of state programs. The purpose of the study was to study the dynamics of indices of primary morbidity of adult population of Federal districts and subjects of the Russian Federation in 2006-2011 and 2012-2018. The analysis established the subjects of the Russian Federation where the mentioned indices factually remained unchanged or had negative dynamics. Also, the periods of health care reform with positive dynamics of indices of primary morbidity were determined. Besides, reforming process was not always systematic and not all planned tasks were completed that , resulted in significant discrepancies in values of indices of primary morbidity among particular subjects of the Russian Federation. This kind of analysis permits to identify specific directions of improving regional policy in health care.

[The quality of coding medical information as component of system of management of medical activities quality].

The reliable statistical information is undoubtedly an important point in making any management decisions. The main instrument for recording and analyzing health data is international statistical classification of diseases and related health problems, 10th revision. The article presents results of study of quality of coding information concerning hospital morbidity and mortality of patients of palliative care department of multidisciplinary hospital.

[Opportunities and Problems of Analysis of Mortality from Myocardial Infarction According to Medical Certificates of Death (on the Example of the Tula Region)].

AIM: to analyze the quality of completion medical certificates of death (MCD) of residents of the Tula region, in which in 2017 acute and subsequent myocardial infarction (MI) was listed as the underlying cause of death (UCD) or as multiple causes of death (MC). MATERIALS AND METHODS: From the electronic database (DB) of MCD of residents of Tula region for 2017 we selected all MSD in which MI was written down irrespective of a section of MCD. A total of 689 MSD (43.8% men and 56.2% women) were analyzed. RESULTS: Mean age of the deceased was 72.6±11.3 years (men 67.25±0.62; women 76.7±9.8; p<0.001). Multimorbid pathology was registered in 31.5% of the deceased. In 77.9% of cases myocardial infarction was selected as the UCD and in 22.1% - as a complication of other diseases. Among registered MI complications were hemotamponade (24.5%), cardiogenic shock (3.6%), ventricular fibrillation (0.3%), heart failure (50.2%). Complications of MI were not listed in 3.9% of MCD. Analysis of MCD showed that their completion did not comply with established ICD-10 rules and recommendations of Ministry of Health of RF; all lines were filled out only in 1% of completed MCD. Also, problems of determining the initial cause of death when myocardial infarction occurred in the presence of multimorbid pathology were revealed. CONCLUSION: Mortality analysis using solely UCD leads to decreasing mortality rates from MI, and unsatisfactory quality of filling the MCD decreases the ability to identify MC, that prevents the correction of priorities in the organization of medical care. The revealed problems of coding causes of death require urgent solutions from the professional community of cardiologists, pathologists, and the Ministry of Health.

[Trends in stroke mortality rates in Russia and the USA over a 15-year period]. / Dinamika pokazatelei smertnosti naseleniia ot ostrogo narusheniia mozgovogo krovoobrashcheniia v Rossii i SShA za 15-letnii period.

AIM: to comparatively analyze standardized mortality ratios (SMR) from stroke in the populations aged over 30 years in the Russian Federation and in the USA over a 15-year period. MATERIAL AND METHODS: The analysis included nontraumatic subarachnoid hemorrhage (NTSH) (a group of ICD-10 codes I60), nontraumatic intracerebral hemorrhage (NTIH) (I61), cerebral infarction (CI) (I63), and stroke, not specified as hemorrhage or infarction (SNSHI) (I64). The new European standard (European Standard Population.2013) was used for standardization. The data of the Federal State Statistics Service of the Russian Federation, those of the World Health Organization Mortality Database (WHO MD) and Human Mortality Database (HMD) for the USA were applied. RESULTS: During the considered period, 30-49-year-old Russian men showed a reduction in SMRs from NTSH (I61) by 9.0% (from 18.9 to 17.2 per 100,000 population), from SNSHI (I64) by 10 times (from 12.5 to 1.3); SMRs from CI (I63) increased by 4.3% (from 6.9 to 7.2). In men aged 50 years and older, SMRs from NTIH and SNSHI decreased by 32.3% (from 143.2 to 97.0) and by 10 times (from 580.8 to 60.6), respectively; those from CI increased by 13.8% (from 229.8 to 261.4). In the USA, 30-49-year-old men displayed 26.1% and 2-fold decreases in SMRs from NTIH (from 2.5 per 100,000 population in 1999 to 1.7 in 2013) and CI (from 1.8 to 0.9), respectively; those from SNSHI remained unchanged (1.3). In men aged 50 years and older, SMRs from NTIH, CI, and SNSHI reduced by 39.7% (from 29.0 to 17.5), by 2 times (from 1.8 to 0.9), and by 2 times (143.0 to 72.5), respectively. 30-49-year-old Russian women exhibited a 22.2% reduction in SMRs from NTIH (from 9.0 to 7.0), a 4.3% increase in those from CI (from 2.7 to 2.8), and an 11-fold decrease in those from SNSHI (from 5.5 to 0.5). Women aged 50 years and older showed changes in SMRs from the codes in the same sequence from 105.6 to 60.5, from 172.8 to 189.6, and from 466.5 to 43.7, respectively. In the USA, 30-49-year-old women displayed reductions in SMRs from NTIH by 10.0% (from 1.5 to 0.9), from CI by 33.3% (from 0.3 to 0.2), and from SNSHI by 10% (from 1.0 to 0.9). Women aged 50 years and older exhibited changes in SMRs from the codes in the same sequence from 24.0 to 14.8), n those from CI (from 20.6 to 6.7) and from SNSHI (from 6.5 to 10.3). CONCLUSION: In Russia, the reduction in mortality rates from the above causes (which is most significant from that in NTSH may be associated with both medical and socioeconomic factors, including with the improved prevention and organization of medical care. The differences in SMRs between the two countries may be related to the principles in the organization and control of coding of the causes of death.

[Procedure for coding the causes of death in some circulatory system diseases].

The paper deals with the unification of requirements for coding the causes of death in circulatory system diseases, by taking into account the recently updated ICD-10 and the Consensus of the Expert Council Task Force on Pathological Anatomy, Ministry of Health of the Russian Federation (27 February 2014).

[The order of coding road traffic injuries in accordance with ICD-10 at government forensic medical expertise institutions of the Russian Federation].

The authors describe the order of coding road traffic injuries in accordance with the 10th edition of the International Classification of the Disease (ICD-10) at government forensic medical expertise institutions of the Russian Federation. In addition, they analyse the application of the coding rules and the identification of the primary causes of death with a view to obtaining reliable road traffic accident mortality statistics compatible with the respective internationally available data. Special attention is given to the consideration and recommendation of the rules for making forensic medical diagnosis in accordance with the requirements of ICD-10 and its inclusion in the road traffic death certificates. The authors emphasize the importance of compliance with the rules for formulation of medical death certificates and identification of the cause of the fatal outcome for the reliable calculation of such demographically significant characteristic as road traffic accident mortality.

Continuous modeling of metabolic networks with gene regulation in yeast and in vivo determination of rate parameters.

A continuous model of a metabolic network including gene regulation to simulate metabolic fluxes during batch cultivation of yeast Saccharomyces cerevisiae was developed. The metabolic network includes reactions of glycolysis, gluconeogenesis, glycerol and ethanol synthesis and consumption, the tricarboxylic acid cycle, and protein synthesis. Carbon sources considered were glucose and then ethanol synthesized during growth on glucose. The metabolic network has 39 fluxes, which represent the action of 50 enzymes and 64 genes and it is coupled with a gene regulation network which defines enzyme synthesis (activities) and incorporates regulation by glucose (enzyme induction and repression), modeled using ordinary differential equations. The model includes enzyme kinetics, equations that follow both mass-action law and transport as well as inducible, repressible, and constitutive enzymes of metabolism. The model was able to simulate a fermentation of S. cerevisiae during the exponential growth phase on glucose and the exponential growth phase on ethanol using only one set of kinetic parameters. All fluxes in the continuous model followed the behavior shown by the metabolic flux analysis (MFA) obtained from experimental results. The differences obtained between the fluxes given by the model and the fluxes determined by the MFA do not exceed 25% in 75% of the cases during exponential growth on glucose, and 20% in 90% of the cases during exponential growth on ethanol. Furthermore, the adjustment of the fermentation profiles of biomass, glucose, and ethanol were 95%, 95%, and 79%, respectively. With these results the simulation was considered successful. A comparison between the simulation of the continuous model and the experimental data of the diauxic yeast fermentation for glucose, biomass, and ethanol, shows an extremely good match using the parameters found. The small discrepancies between the fluxes obtained through MFA and those predicted by the differential equations, as well as the good match between the profiles of glucose, biomass, and ethanol, and our simulation, show that this simple model, that does not rely on complex kinetic expressions, is able to capture the global behavior of the experimental data. Also, the determination of parameters using a straightforward minimization technique using data at only two points in time was sufficient to produce a relatively accurate model. Thus, even with a small amount of experimental data (rates and not concentrations) it was possible to estimate the parameters minimizing a simple objective function. The method proposed allows the obtention of reasonable parameters and concentrations in a system with a much larger number of unknowns than equations. Hence a contribution of this study is to present a convenient way to find in vivo rate parameters to model metabolic and genetic networks under different conditions.

[Hyperhomocystinemia and 677C T methylenetetrahydrofolate reductase polymorphism as a cardiovascular risk factor in childhood]. / Hiperhomocistinemia y polimorfismo 677C T de la 5,10-metilenotetrahidrofolato reductasa en hijos de pacientes con enfermedad coronaria prematura.

BACKGROUND: Factors related to hyperhomocystinemia in the pediatric population of our geographical area with a parental history of premature coronary disease (PCD) are not well known. OBJECTIVES: To evaluate the possible association between plasma total homocysteine (tHcy), the B vitamins involved in its metabolism (folate, vitamin B12 and B6), and 677C T polymorphism of methylenetetrahydrofolate reductase (MTHFR) in a group of children with a parental history of PCD. METHODS: A cross-sectional analytical study of 80 children (aged 5-18 years old) with a parental history of PCD was performed. Values found in these children were compared with reference values for similar age groups. Plasma tHcy and vitamin B6 were evaluated by high-performance liquid chromatography with fluorometric detection. Folate and vitamin B12 concentrations were determined by radioimmunoassay. Detection of 677C T polymorphism of MTHFR was performed using polymerase chain reaction amplification and Hinfl digestion. Statistical analysis was performed using the SPSS program, version 10.0. Concentrations of tHcy and vitamins were compared using the Mann-Whitney U-test and Spearman's correlation coefficient. The association between phenotype, hyperhomocystinemia and low vitamin concentrations was analyzed using the chi-squared test. ResultsPlasma tHcy values in the children aged more than 10 years with a parental history of PCD were significantly higher (p < 0.001) than the reference values. Vitamin B12 levels were significantly lower (p 0.015), but neither folate nor vitamin B6 levels differed from the reference values. A negative correlation (p < 0.0001) was observed between tHcy and folate (r 0.47) and between tHcy and vitamin B12 levels (r 0.51). Eighty percent of the children with the TT genotype of MTHFR showed hyperhomocystinemia. Suboptimal vitamin B levels were also associated with the TT genotype of MTHFR. CONCLUSIONS: Hyperhomocystinemia detected in children with a parental history of PCD is associated with the TT genotype of MTHFR and with low folate levels. Because hyperhomocystinemia can be corrected by vitamin B supplementation, tHcy determination is recommended in the offspring of patients with PCD.

Hiperhomocistinemia y polimorfismo 677ct de la 5,10-metilenotetrahidrofolato reductasa en hijos de pacientes con enfermedad coronaria prematura / Hyperhomocystinemia and 677CT methylenetetrahydrofolate reductase polymorphism as a cardiovascular risk factor in childhood

Antecedentes: Los factores relacionados con la hiperhomocistinemia en la población pediátrica con historia de enfermedad coronaria prematura (ECP) no son bien conocidos. Objetivos: Evaluar la posible asociación entre la homocisteína plasmática, las vitaminas B (folatos, B12 y B6) y el polimorfismo 677C T de la enzima 5,10-metilenotetrahidrofolato reductasa (MTHFR) en un grupo de hijos de progenitores con ECP. Métodos: Estudio transversal analítico de 80 hijos (5-18 años) de progenitores con ECP comparando sus valores con los de referencia de edades similares. homocisteína total y vitamina B6: cromatografía líquida de alta resolución (HPLC) con detección fluorimétrica; folato y vitamina B12: radioinmunoanálisis; polimorfismo 677C T de la MTHFR: amplificación por reacción en cadena de la polimerasa (PCR) y digestión con Hinfl. Estudio estadístico (SPSS, versión 10.0). Comparaciones: U de Mann-Witney y chi cuadrado; correlaciones de Spearman. Resultados: Los valores de homocisteína total de los hijos de progenitores con ECP mayores de 10 años fueron significativamente superiores (p < 0,001) a los valores de referencia, mientras que los de vitamina B12 fueron inferiores (p 0,015), aunque no los de folato y vitamina B6. Se observó una correlación negativa (p < 0,0001) entre la homocisteína total y el folato (r -0,47) y la vitamina B12 (r-0,51). El 80 por ciento de los hijos con el genotipo TT de la MTHFR presentaron hiperhomocistinemia. Los valores subóptimos de vitaminas mostraron también una asociación el genotipo TT. Conclusiones: La hiperhomocistinemia de los hijos de pacientes con ECP de nuestro medio se asocian al genotipo TT de la MTHFR y a unas concentraciones bajas de folato. La posibilidad de corregir la hiperhomocistinemia mediante suplementación vitamínica sugiere el interés del estudio familiar de homocisteína en la ECP (AU)

Therapeutic potential of GP IIb/IIIa receptor antagonists in acute myocardial infarction.

The management of acute myocardial infarction (AMI) has changed dramatically over the last two decades, with the addition of fibrinolytic agents and primary coronary intervention (PCI). The more recent development of the glycoprotein (GP) IIb/IIIa antagonists, a new class of potent antiplatelet drugs, has the potential to considerably enhance the treatment of AMI patients. A number of recent studies have highlighted the potential incremental benefits with adjunctive IIb/IIIa-targeted therapy. In this review, we will discuss the pathophysiology of myocardial infarction (MI), the physiology and role of platelets in thrombosis and describe the currently available drugs. We will briefly summarise the results of recent clinical trials, discuss some key forthcoming trials and attempt to describe how GP IIb/IIIa antagonists may directly impact the immediate and near future day-to-day care of patients with AMI.