Ischemic heart disease: medical certificate of cause of death analysis

Aim. According to data from the Moscow Oblast civil registry office in 2020, to analyze medical certificates of cause of death (MCCD), where the code from “Ischemic heart disease” (IHD) (I20-I25) group is indicated as underlying cause of death (UCD).Material and methods. A total of 23193 deaths with I20-I25 codes (UCDs) were included. We assessed the prevalence of individual IHD types, the frequency and patterns of complications, the average age of deceased persons, the proportion of women and men, place of death registration.Results. The average age of the deceased was 73,6±12,5 (men, 68,8±10,5; women, 78,4±12,5; p<0,0001). The proportion of women who died under the age of 70 was <20%, men — >50%. Half of the deaths were registered at home, a third in a hospital, and the rest elsewhere. Taking into account age and sex, inhospital death from myocardial infarction (MI) is recorded 12 times more often than in “other forms of acute IHD”. Chronic forms of IHD were registered in 76,9% of cases; in 47,3%, such IHD form as “Atherosclerotic heart disease” was noted. The proportion of deaths from acute MI and deaths after MI was 37,3%. In 92,1% of MCCDs of “other forms of acute IHD”, “acute coronary insufficiency” is indicated. Differences in the prevalence of various IHD forms between men and women were significant (p<0,0001). In female mortality pattern, there are 3 times less deaths from other (non-MI) acute forms of IHD and almost 2 times less deaths from old myocardial infarction and cardiac aneurysm. As the immediate cause of death, heart failure was indicated in 78,9%, while among those with prior MI — in 91%. In other acute forms of IHD, acute coronary insufficiency was indicated in 89%.Conclusion. A high proportion of deaths with unspecified acute and chronic forms of IHD as the cause of death, especially in young men, requires a comprehensive study and development by the Russian Society of Cardiology of criteria for death from various IHD forms

СТРЕПТОКОККОВАЯ (ГРУППЫА) ИНФЕКЦИЯ ВРОССИИ: СОСТОЯНИЕ ПРОБЛЕМЫ И ТЕНДЕНЦИИ РАЗВИТИЯ

Aim. To assess the current situation on streptococcal (group A) infection in Russia, to study the molecular properties and antimicrobial susceptibility of group A streptococcus isolated from patients with soft tissue infection.Materials and methods. We performed a descriptive epidemiological study using official statistics. A total of 97 cases of soft tissue infection caused by group A streptococci were investigated for emm-types, the presence of genes of bacteriophage toxins and integrases by PCR and sequencing. We tested 91 strains for antimicrobial susceptibility by the micro dilution methods.Results. From 2009 through 2017, 2.8 million cases (563 thousand primary cases) of group A streptococcal disease were reported. There was a decrease in the incidence of scarlet fever in Russia (31.5 per 100 000 population). In 2009–2017 the incidence of rheumatic fever and rheumatic heart diseases increase slightly but the prevalence of this forms group A streptococcal disease are decrease. Annually 2600 people die from the rheumatic fever and rheumatic heart diseases. Of the 97 cultures of group A streptococci, 33 were associated with invasive infection. We identified 33 different emm-type. All cultures contained speB gene. Some strains contained speA, and others speC genes. We did not find any correlation between the presence of bacteriophage toxin genes and the invasive properties of streptococci. Tetracycline and macrolides are ineffective in patients with of soft tissue infectionConclusion. Streptococcal (group A) infection continues to be of significant social and economic importance for Russia. The streptococcus cultures isolated from patients with invasive forms were heterogeneous in molecular and biological properties and remained sensitive to penicillin antibiotics.Цель: оценить современную ситуацию по стрептококковой (группы А) инфекции в России, изучить молекулярно-биологические свойства и чувствительность к антибактериальным препаратам культур стрептококка группы А, выделенных от больных с инфекцией мягких тканей.Материалы и методы. Описательное исследование проведено на основании данных официаль-ой статистической отчетности. 97 культур стрептококка группы А, выделенных от больных с инфекцией мягких тканей, были исследованы на принадлежность к emm-типам, наличие генов бактериофаговых токсинов и интеграз с помощью ПЦР и секвенирования. Из них 91 штамм был исследован на чувствительность к антибиотикам методом микроразведений. Результаты. В целом за 2009–2017 гг. в России, по данным официальной регистрации, было выявлено около 2,8 млн случаев заболеваний, непосредственно связанных со стрептококком группы А, из которых 563 тысячи были выявлены впервые. Заболеваемость скарлатиной в России за исследуемый период снижалась (31,5 на 100 тысяч населения). За 2009–2017 гг. отмечается некоторое увеличение заболеваемости ревматической лихорадкой и ревматическими болезнями сердца при снижении распространенности. Смертность, связанная с ревматической лихорадкой и ревматическими болезнями сердца, также снижается (ежегодно в среднем умирает 2,6 тысячи человек).Из 97 выделенных культур стрептококков группы А 33 были связаны с инвазивной инфекцией. Всего установлено 33 различных emm-типа воз-будителя. Ген speB был выявлен у всех культур. Гены остальных исследуемых токсинов (speA, speC) встречались у ряда штаммов. Корреляции между наличием генов бактериофаговых токсинов и агрессивностью стрептококков обнаружено не было. Использование тетрациклина и макролидов для лечения инфекции мягких тканей неэффективно.Заключение. Стрептококковая (группы А) инфекция продолжает представлять значительную социальную и экономическую значимость для России. Выделенные от больных с инвазивными формами культуры стрептококка были гетерогенны по молекулярно-биологическим свойствам и сохраняли чувствительность к антибиотикам пенициллинового ряда

Сравнение классификаций и обоснование необходимости трансдисциплинарного консенсуса для учета заболеваемости и смертности, ассоциированной с хронической сердечной недостаточностью

A significant number of studies on chronic heart failure (CHF) are published worldwide. However, the issue of uniform criteria and approaches to accounting for ambulatory care and mortality associated with this pathology in patient accounting systems has remained resolved, meaning the data and indicators obtained in different regions and countries are not comparable. The aim of the article is to substantiate the need for discussion in the Russian Society of Cardiology on the possibility, principles and methodology of uniform accounting of ambulatory care, hospitalizations and deaths associated with chronic heart failure in healthcare using the classifications of heart failure applied in clinical practice.Основные положения. Статья посвящена анализу применения используемых в клинической практике классификаций хронической сердечной недостаточности для учета случаев амбулаторного лечения, госпитализаций, смертей и возможности сравнения этих данных. Для получения сопоставимых (по регионам, странам) данных о распространенности, госпитализации и смерти, ассоциированной с хронической сердечной недостаточностью, требуются согласованные критерии сердечной недостаточности и единые правила учета в информационных системах.Резюме. В мировой литературе представлено значительное число исследований, посвященных хронической сердечной недостаточности. Однако до сих пор не решен вопрос единых критериев и подходов к учету случаев оказания медицинской помощи и смерти, ассоциированной с данной патологией, вследствие чего результаты работ и показатели регионов и разных стран малосопоставимы. Цель статьи – обоснование необходимости дискуссии на уровне Российского кардиологического общества о возможности, принципах и методике единообразного учета в системе здравоохранения случаев амбулаторного лечения, госпитализаций и смертей, ассоциированных с хронической сердечной недостаточностью, на основе используемых в клинической практике классификаций заболевания

STREPTOCOCCAL (GROUP A) INFECTION IN RUSSIA: STATE OF THE PROBLEM AND DEVELOPMENT TRENDS

Aim. To assess the current situation on streptococcal (group A) infection in Russia, to study the molecular properties and antimicrobial susceptibility of group A streptococcus isolated from patients with soft tissue infection.Materials and methods. We performed a descriptive epidemiological study using official statistics. A total of 97 cases of soft tissue infection caused by group A streptococci were investigated for emm-types, the presence of genes of bacteriophage toxins and integrases by PCR and sequencing. We tested 91 strains for antimicrobial susceptibility by the micro dilution methods.Results. From 2009 through 2017, 2.8 million cases (563 thousand primary cases) of group A streptococcal disease were reported. There was a decrease in the incidence of scarlet fever in Russia (31.5 per 100 000 population). In 2009–2017 the incidence of rheumatic fever and rheumatic heart diseases increase slightly but the prevalence of this forms group A streptococcal disease are decrease. Annually 2600 people die from the rheumatic fever and rheumatic heart diseases. Of the 97 cultures of group A streptococci, 33 were associated with invasive infection. We identified 33 different emm-type. All cultures contained speB gene. Some strains contained speA, and others speC genes. We did not find any correlation between the presence of bacteriophage toxin genes and the invasive properties of streptococci. Tetracycline and macrolides are ineffective in patients with of soft tissue infectionConclusion. Streptococcal (group A) infection continues to be of significant social and economic importance for Russia. The streptococcus cultures isolated from patients with invasive forms were heterogeneous in molecular and biological properties and remained sensitive to penicillin antibiotics

COVID-19: urgent questions for estimating morbidity, prevalence, case fatality rate and mortality rate

During epidemics, the usual statistical approaches will not allow determining the readiness of the public health system to take urgent measures to counteract the increase in morbidity, spread and mortality of the population. The quality of the medical, socio-economic and managerial decisions at all levels will depend on the accuracy of statistical data and the possibility of creating adequate prognostic models. However, there are still problems with the identification of COVID-19 cases and the diagnostic accuracy of the methods used. Complex analytical efforts require in order to determine the COVID-19 impact on the health status and case fatality rate/mortality rate

STATISTICAL, CLINICAL AND MORPHOLOGICAL CLASSIFICATIONS OF CORONARY HEART DISEASE — POSSIBLE TO UNITE?

A problem of synonymy and synonyms legitimation is of big importance in practice, as multiple classifications lead to problems of organization and provision of medical care, and incorrect statistics. The article is a consensus of experts on the issue of agreement/implementation of clinical classifying of synonyms of terms listed in ICD-10, agreement on the modern clinical and morphological terms