Indicators for digitalization of sustainable development goals in peex program

cited By 0This article describes the Pan-Eurasian Experiment (PEEX) program and indicators for monitoring of implementation and digitalization of Sustainable Development Goals (SDG) in Russia, especially environmental goals. The authors considered the possibility of integration and identification of the methodological approaches of the socio-economic research to environmental sciences. Paper gives insights into the international framework of the United nations, addreses several relevant indicators to be monitored in a Russian perspective and summarizes shortly the status of the monitoring activities and provide an overview on the main tasks for the upcoming years to reach the sustainable development goals established by the United Nations. The tasks to which the Goals divided are considered in detail. The indicators of Russian statistics that can be used to monitor the implementation of these tasks are determined. It is shown, that more detailed regional analysis and new data is needed in order to quantify the feedbackloops. © 2018, Lomonosov Moscow State University. All rights reserved.Peer reviewe

ДИАГНОСТИЧЕСКИЕ, КЛИНИЧЕСКИЕ И ПРОГНОСТИЧЕСКИЕ АСПЕКТЫОПРЕДЕЛЕНИЯ КОНЦЕНТРАЦИИ С-РЕАКТИВНОГО БЕЛКА ПРИ ХРОНИЧЕСКОЙ СЕРДЕЧНОЙ НЕДОСТАТОЧНОСТИ

A lot of mechanisms in development and progression of cardiac dysfunction are associated with changes of multiple markers and high-sensitivity C-reactive protein is one of them. The role of this inflammatory marker in heart failure pathogenesis requires further study. However, various recent reports have suggested that C-reactive protein assessment may be used for prediction of incident heart failure, its prognosis and estimation of the disease severity.Многообразие механизмов развития и прогрессирования кардиальной дисфункции при недостаточности кровообращения ассоциировано с изменениями концентрации различных биомаркёров, одним из которых является С-реактивный белок. Роль этого биомаркёра воспаления в реализации различных звеньев патогенеза сердечной недостаточности требует дальнейшего всестороннего анализа. В ряде исследований продемонстрирована взаимосвязь С-реактивного белка с риском развития недостаточности кровообращения, оценкой тяжести течения заболевания и прогноза

ДИАГНОСТИЧЕСКИЕ, КЛИНИЧЕСКИЕ И ПРОГНОСТИЧЕСКИЕ АСПЕКТЫОПРЕДЕЛЕНИЯ КОНЦЕНТРАЦИИ С-РЕАКТИВНОГО БЕЛКА ПРИ ХРОНИЧЕСКОЙ СЕРДЕЧНОЙ НЕДОСТАТОЧНОСТИ

A lot of mechanisms in development and progression of cardiac dysfunction are associated with changes of multiple markers and high-sensitivity C-reactive protein is one of them. The role of this inflammatory marker in heart failure pathogenesis requires further study. However, various recent reports have suggested that C-reactive protein assessment may be used for prediction of incident heart failure, its prognosis and estimation of the disease severity.Многообразие механизмов развития и прогрессирования кардиальной дисфункции при недостаточности кровообращения ассоциировано с изменениями концентрации различных биомаркёров, одним из которых является С-реактивный белок. Роль этого биомаркёра воспаления в реализации различных звеньев патогенеза сердечной недостаточности требует дальнейшего всестороннего анализа. В ряде исследований продемонстрирована взаимосвязь С-реактивного белка с риском развития недостаточности кровообращения, оценкой тяжести течения заболевания и прогноза

Community-acquired pneumonia in patients with chronic heart failure: Clinical manifestation and a diagnostic role of biomarkers

The aims of this study were to evaluate clinical course of community-acquired pneumonia (CAP) in patients with chronic heart failure (CHF) and to assess the time course of serum biomarkers, such as C-reactive protein (CRP), procalcitonin (PCT), interleukin-6 (IL-6), tumor necrosis factor α (TNF-α), and brain natriuretic peptide (BNP), at baseline and after treatment in patients with CAP and CHF. Methods. This was a prospective observational study. Adult patients with CHF admitted to a hospital due to suspected CAP were recruited in the study. The diagnosis of CAP was confirmed by chest computed tomography (CT). Subsequently, patients were assigned to the group 1 (with confirmed CAP) or the group 2 (with respiratory infections other than CAP). Echocardiography was performed in all patients at baseline and in follow-up visits. In addition to the routine clinical examination and laboratory tests, serum biomarkers were measured in all patients at admission (Visit 1), at days 10 to 14 (Visit 2), and at days 28 to 42 (Visit 3). Standard statistical methods were used for data analysis. Results. Seventy patients who met the inclusion criteria were enrolled in this study; of them, 35 patients had confirmed CAP and 35 patients had respiratory infections other than CAP. Both groups were similar for demographic and clinical characteristics, as well as for laboratory, echocardiographic and radiological findings. CAP did not affect the clinical course of CHF and echocardiographic parameters did not differ significantly between the groups. Clinical signs of both diseases improved after the treatment in majority of patients. Echocardiographic parameters also improved in both groups that indicates the improvement in cardiac dysfunction under the treatment. During the follow-up, the most prominent changes were seen in CRP level which was significantly higher at baseline in CAP patients compared to patients with other respiratory infections. CRP level decreased at Visit 2 in both groups and in Visit 3 in CAP group. CRP levels differed significantly between the groups both at Visits 1 and 2. Other biomarkers, such as PCT, IL-6, and BNP, were significantly higher at Visit 1 compares to Visit 2. TNF-α level did not change significantly neither in any group during the study nor between the groups at any study time. Conclusion. CAP did not affect the clinical course of CHF. Inflammatory biomarkers, such as CRP, PCT, and IL-6, could be used additionally to the routine diagnostic procedures to differentiate between CAP and other respiratory infections in patients with CHF. CRP is the most promising biomarker. Serum levels of the biomarkers decreased significantly under the standard hospital treatment of CAP and CHF; this could be considered to evaluate treatment success and prognosis. © 2019 Medical Education. All rights reserved

C-reactive protein evaluation in community-acquired pneumonia with comorbid chronic heart failure as criterion of antibiotic prescription [Определение C-реактивного белка при внебольничной пневмонии на фоне хронической сердечной недостаточности как критерий назначения антибактериальной терапии]

Aim. To prove that diagnostic algorithm based on additional measurement of serum C-reactive protein (CRP) for administration of systemic antibacterial therapy (ABT) to patients with suspected community-acquired pneumonia (CAP) and concomitant chronic heart failure (CHF) does not influence outcomes of disease. Materials and methods. This open, single-center, randomized, prospective, non-inferiority study included 160 adult patients with documented functional class II–IV CHF who had been admitted with a preliminary diagnosis of non-severe CAP. Patients were randomized at 1:1 to two groups; group 1 – with additional measurement of CRP (n=80) and group 2 – with the use of routine diagnostic methods (n=80). In group 1, systemic ABT was administered only when serum CRP was >28.5 mg/l (threshold level of the biomarker calculated at the previous stage of the study); group 2 received a standard treatment. Non-inferiority test result for both algorithms was evaluated by the number of patients with clinical success on days 12–14 (primary endpoint). Non-inferiority margin was δ=–13.5%. In addition secondary endpoints (early clinical response on days 3–5; early in-hospital adverse events (development of complications; admission to intensive care unit (ICU); death), death, recurrent CAP or CHF worsening with readmission at 28 day; mortality at 90 and 180 days) were estimated. Standard statistical tools were used for all intergroup comparisons. Results: 76 patients of each group reached the primary endpoint. Systemic ABT was administered to 51 (67.1%) patients in group 1 and 76 (100%) patients in group 2 (p0.05) regarding all endpoints: clinical success, 70 (92.1%) vs. 69 (90.8%), Δ=1.3% (one-sided 97.5% CI: – 8.25% for non-inferiority margin δ=–13.5%); early clinical response, 66 (86.8%) vs. 68 (89.5%); admission to ICU, 1 (1.3%) vs. 1 (1.3%); development of complications, 20 (26.3%) vs. 22 (28.9%); readmission, 5 (6.6%) vs. 6 (7.9%); in-hospital mortality, 2 (2.6%) vs. 1 (1.3%), mortality at 28 day, 3 (3.9%) vs. 2 (2.6%), at 90 day, 5 (6.6%) vs. 4 (5.3%), at 180 day, 8 (10.5%) vs. 9 (11.8%) cases, respectively. Conclusion: additional measurement of serum CRP in patients with CHF and suspected non-severe CAP was able to reduce rate of systemic ABT administration without outcomes and prognosis worsening. © 2018 Media Sphera Publishing Group.All rights reserved

Определение C-реактивного белка при внебольничной пневмонии на фоне хронической сердечной недостаточности как критерий назначения антибактериальной терапии

Aim. To prove that diagnostic algorithm based on additional measurement of serum C-reactive protein (CRP) for administration of systemic antibacterial therapy (ABT) to patients with suspected community-acquired pneumonia (CAP) and concomitant chronic heart failure (CHF) does not influence outcomes of disease.Materials and methods. This open, single-center, randomized, prospective, noninferiority study included 160 adult patients with documented functional class II–IV CHF who had been admitted with a preliminary diagnosis of non-severe CAP. Patients were randomized at 1:1 to two groups; group 1 – with additional measurement of CRP (n=80) and group 2 – with the use of routine diagnostic methods (n=80). In group 1, systemic ABT was administered only when serum CRP was >28.5 mg / l (threshold level of the biomarker calculated at the previous stage of the study); group 2 received a standard treatment. Noninferiority test result for both algorithms was evaluated by the number of patients with clinical success on days 12–14 (primary endpoint). Non-inferiority margin was δ=–13.5 %. In addition secondary endpoints (early clinical response on days 3–5; early in-hospital adverse events (development of complications; admission to intensive care unit (ICU); death), death, recurrent CAP or CHF worsening with readmission at 28 day; mortality at 90 and 180 days) were estimated. Standard statistical tools were used for all intergroup comparisons.Results: 76 patients of each group reached the primary endpoint. Systemic ABT was administered to 51 (67.1 %) patients in group 1 and 76 (100 %) patients in group 2 (p0.05) regarding all endpoints: clinical success, 70 (92.1 %) vs. 69 (90.8 %), Δ=1.3 % (one-sided 97.5 % CI: – 8.25 % for non-inferiority margin δ=–13.5 %); early clinical response, 66 (86.8 %) vs. 68 (89.5 %); admission to ICU, 1 (1.3 %) vs. 1 (1.3 %); development of complications, 20 (26.3 %) vs. 22 (28.9 %); readmission, 5 (6.6 %) vs. 6 (7.9 %); in-hospital mortality, 2 (2.6 %) vs. 1 (1.3 %), mortality at 28 day, 3 (3.9 %) vs. 2 (2.6 %), at 90 day, 5 (6.6 %) vs. 4 (5.3 %), at 180 day, 8 (10.5 %) vs. 9 (11.8 %) cases, respectively.Conclusion: additional measurement of serum CRP in patients with CHF and suspected non-severe CAP was able to reduce rate of systemic ABT administration without outcomes and prognosis worsening.Цель. Доказать, что алгоритм назначения системной антибактериальной терапии (АБТ) у пациентов с предполагаемой внебольничной пневмонией (ВП) и сопутствующей ХСН, основанный на дополнительном определении уровня С-реактивного белка (С-РБ) в сыворотке крови, не влияет на исходы заболевания.Материалы и методы. Открытое одноцентровое рандомизированное проспективное исследование не меньшей эффективности включало 160 взрослых пациентов с доказанной ХСН II–IV ФК, госпитализированных с предварительным диагнозом нетяжелой ВП. Больные были рандомизированы в соотношении 1:1 в две группы: 1 – с дополнительным определением уровня С-РБ (n=80), 2 – с использованием рутинных методов диагностики (n=80). Системная АБТ в группе 1 назначалась только при сывороточной концентрации С-РБ >28,5 мг / л (пороговый уровень биомаркера, рассчитанный на предшествующем этапе исследования), группа 2 получала стандартное лечение. Проверка гипотезы не меньшей эффективности предложенного алгоритма по сравнению с общепринятым проводилась по доле пациентов, достигших клинического успеха на 12–14 день лечения (первичная конечная точка). Граница не меньшей эффективности была принята равной δ=–13,5 %. Дополнительно оценивались вторичные конечные точки: ранняя клиническая эффективность терапии на 3–5 день, ранние неблагоприятные исходы в стационаре (развитие осложнений, перевод в отделение реанимации и интенсивной терапии (ОРИТ), смерть), смерть или повторная госпитализация по поводу рецидива ВП / декомпенсации ХСН на 28 день, летальность на 90, 180 день. Межгрупповые различия по данным показателям, а также по всем остальным параметрам рассчитывались с использованием стандартных статистических методов.Результаты. Первичной конечной точки достигли 76 больных в каждой группе. Системную АБТ в группе 1 получал 51 (67,1 %) пациент, а в группе 2–76 (100 %), p0,05) по всем конечным точкам исследования: клинический успех – 70 (92,1 %) и 69 (90,8 %), Δ=1,3 % (односторонний 97,5 % ДИ: – 8,25 % для границы не меньшей эффективности δ=–13,5 %); ранняя клиническая эффективность – 66 (86,8 %) и 68 (89,5 %); перевод в ОРИТ – 1 (1,3 %) и 1 (1,3 %); развитие осложнений – 20 (26,3 %) и 22 (28,9 %); повторная госпитализация – 5 (6,6 %) и 6 (7,9 %); летальность в стационаре – 2 (2,6 %) и 1 (1,3 %), на 28 день – 3 (3,9 %) и 2 (2,6 %), на 90 день – 5 (6,6 %) и 4 (5,3 %), на 180 день – 8 (10,5 %) и 9 (11,8 %) случаев соответственноЗаключение. У пациентов с ХСН и предполагаемым диагнозом нетяжелой ВП дополнительное определение сывороточного С-РБ для решения вопроса о необходимости системной АБТ не ухудшало исходы и прогноз заболевания, однако позволяло существенно снизить частоту назначения антимикробных препаратов

Etiology of community-acquired pneumonia in patients with chronic heart failure [Этиология внебольничной пневмонии у лиц с хронической сердечной недостаточностью]

Chronic heart failure (CHF) is one of the most common comorbidities in elderly patients with community-acquired pneumonia (CAP). The aim of this study was to investigate etiology of CAP in patients with concomitant CHF. Methods. This prospective observational study involved adult hospitalized patients with CAP and concomitant CHF. CAP was confirmed by chest X-ray. Sputum samples or oropharyngeal swabs, blood and urine samples were collected in all eligible patients before starting the therapy with systemic antibiotics. Sputum was cultured for «typical» bacterial pathogens, such as Streptococcus pneumoniae, Staphylococcus aureus, Enterobacterales, etc., in accordance with standard methods and procedures. Mycoplasma pneumoniae, Chlamydophila pneumoniae and respiratory viruses in sputum or oropharyngeal swabs were identified using the real-time polymerase chain reaction (PCR). Urine samples were used to determine serogroup 1 Legionella pneumophila and S. pneumoniae soluble antigens using bedside immunochromatography. Results. Fifty patients were enrolled in the study. The mean age was 72.2 ± 9.5 years, 27 (54%) were females. The etiology of CAP was identified in 23 cases (46%). S. pneumoniae was the most common pathogen (16/23; 69.7%) followed by respiratory viruses (3/23; 13.1%), such as type 3 parainfluenza virus, coronavirus, human metapneumovirus; Haemophilus influenzae (1/23; 4.3%), S. aureus (1/23; 4.3%), and Klebsiella pneumoniae (1/23; 4.3%). S. pneumoniae and parainfluenza virus co-infection was diagnosed in one of 23 patients (4.3%). Conclusion. S. pneumoniae and respiratory viruses were predominant causative pathogens of CAP in hospitalized adults with concomitant CHF. Therefore, bedside tests for urine pneumococcal antigens should be used more widely considering difficult sputum expectoration in elderly. Atypical bacterial pathogens (M. pneumoniae, C. pneumoniae, L. pneumophila) were not identified in this study, so the routine PCR-test and urine tests for L. pneumophila antigens are thought to be not useful. © 2019 Medical Education. All rights reserved