Vol 20, No 3 (2015)

In the management of 148 adult patients with chronic hepatitis C (CHC) of both sexes without special selection (taken into account only absolute contraindications to its performance) there were used domestic basic antiviral drugs - BAD\ (short-living interferons (IFN) a, interferon inducers and nucleoside analogues) in parallel with additional antiviral drugs (drug glycyrrhizinic acid or amantadine) and maintenance therapy (stimulators of T-cell immunity and means of correction of side effects). Treatment was carried out in the framework of the developed complex of principles and approaches including in part, the formation of the starting average weekly dose of interferon IFN with accounting of the character of interferon status of the patient, a gradual increase in the average weekly dose of interferon IFN during the course of therapy, the delayed use of nucleoside analogs and others. As a result, against the background of a significant reduction in financial expenses and the aggressiveness of treatment the stable positive therapeutic outcome in the general population ofpatients occurred in 92.6%, with 87.2% in patients with genotype (G) 1.

The course and outcome of edema and swelling of the brain (OSB) essentially depend on many factors, including the feature of the pathogenesis of the disease associated with the factors ofpathogenicity of the causative agent. There was developed the multivariate mathematical analysis of the clinical picture of OSB with the using of an alternative algorithm of the distributions offrequencies of symptoms in differentiated groups of patients with the presence of OSB and without of OSB signs of this complication that permitted to make more accurately diagnose of OSB and judge the effectiveness of the taken therapy. The lack of clinical effect of antibiotic therapy is caused among other things the low bioavailability of the pathogen. BBB is not associated with an HLB so attempts on the base of the measurement of the spinal fluid pressure to detect the presence and severity of OSB have not been scientifically justified. The analysis of CSF indices - lactate, protein, glucose, D-DF, pH level against the background of OSB will allow to avoid unsound replacement of etiotropic drugs

The article presents the results of an open comparative randomized clinical study on the assessment of the reactogenicity, safety and immunogenicity of the domestic vaccine "EntseVir®" with reduced antigenic load in immunization of children aged 3 to 17 years on the schedule for 0-60 days. The vaccine is characterized by the low reactogenicity, high safety profile and immunogenicity. On main indices, it is not inferior to foreign vaccine «FSME-Immun Inject / Junior».

The purpose of the study The improvement the diagnosis and prognosis of the course of leptospirosis on the basis of the study of characteristics of clinical picture and pathomorphogenesis, determination of the main causes of lethal outcomes at different stages of the disease, in dependence on the level of the management of specialized medical care. Materials and methods There were analyzed medical records and autopsy protocols of 168 patients who died from leptospirosis in the Krasnodar region in 1969-2014 and medical records of 125 patients with both severe course of leptospirosis and the development of multiple organ insufficiency. 4 groups were considered: 1st -patients died in 1969-1988 before applying of efferent methods therapy, 86 lethal cases; 2nd - patients died in 1989-1997, application of hemosorption and hemofiltration, 31 cases; 3rd - 1998-2008, the use of plasmapheresis and immunocorrectors, 33 cases; 4-th group of 18 patients who died in 2009-2014, up-to-date medical assistance. There was studied autopsy material in 55 patients. The etiological role of L.icterohaemorrhagiae was proved in 75% of lethal cases, L.grippotyphosa - in 16.7%, L.sejroe (Mus 24) - in 8.3%. The results of the study In the initial period at the 3-5 days of illness life-threatening events are toxic shock and hemorrhagic syndrome. In the period of the height of disease (2-3 weeks) polyorganic failure in form of acute renal and hepatic insufficiency , and also combination of hemorrhagic syndrome with acute respiratory distress syndrome assume a great significance Starting From the 4th week, the first place in the risk of the development of the unfavorable outcome is occupied by secondary bacterial complications, sepsis and septic shock. Pathomorphological changes at leptospirosis correspond to organ-system lesions typical for Systemic inflammatory response syndrome - SIRS . Multiple organ dysfunction formed in the height of leptospirosis is a consequence not only of the alternative effect of leptospira and its toxins, but the result of immunopathological reactions of systemic inflammation. At the present time of the observation the lethal outcome occurs in average on the 17,9±2,30 day of illness, the average patient day in reanimation unit is prolonged up to 11,2±2,43. DIC and acute respiratory distress syndrome as a components of multiple organ failure, and at the later stages of the disease - pneumonia and sepsis, indicate to the negative forecast. Risk factors for the unfavorable outcome include late hospitalization and the increased percentage of comorbidity (61%). For the determination of the severity and the prognosis of the course of the disease it is worth to use SIRS criteria and Sepsisrelated Organ Failure (SOFA) rating scale of organ dysfunction. The development of lethal outcome with a probability of 70% is determined in cases with the failure of 4 or more functional systems. The total Score on a SOFA scale in lethal outcomes is 18.7 scores at the first week of illness, and 14.5 scores at the 5-6th weeks. Conclusion The main causes of lethal outcomes leptospirosis are determined by the stage of pathogenesis, depend of the stage of the disease and methods of therapy. The treatment of patients with leptospirosis should be carried out in specialized infectious hospitals with ICUs equipped for efferent methods of detoxification.

There is delivered the panel of 9 hybridomas producing monoclonal antibodies directed to surface thermo-resistant antigenic determinants of V.cholerae El Tor and O139. By immunoblotting method most of MCA were established to react with the corresponding epitopes of protein nature at the level of 38-42 kDa. There were revealed differences in the specific orientation of the MCA to Vibrio cholerae: the first group of MCA identifies antigenic determinants presented only in strains of V. cholerae O1, O139 with genetic characteristic ctx+ tcp+ and ctx- tcp+, but fails to identify strains ctx- tcp-; the second group of MCA identifies common epitopes for V.cholerae El Tor and O139 regardless of ctx and tcp genes. The new panel of MCA can be used as well for the study of the fine antigenic structure of V. cholerae El Tor and O139 as detection of epidemically dangerous strains genotype ctx+ tcp+ with ELISA methods

Information presented in this article gives an overview of scientific and practical activities of the Rostov-on-Don Anti-Plague Institute which celebrated its 80th anniversary in 2014. Two scientific conferences were dedicated to this event: the scientific conference of the Commission for the problem "Cholera and human pathogenic vibrios" was held on June 4-5, 2014 in the context of the Conference of specialists of the Federal Agency on Consumer Rights Protection and Human Welfare Supervision on advancement of cholera epidemiological surveillance. On November 25, 2014 the summing up scientific-practical conference, dedicated to the 80th anniversary of the Rostov-on-Don Anti-Plague Institute took place.