No 1 (2013)

The paper discusses the debatable issues associated with the theoretical and methodological aspects of control of an epidemic process and mass noncommunicable diseases in the population. As to the control of the epidemic process, the author analyzes the formation of the conceptual apparatus and gives the def initions, content, and relationships of the major components of a control system. Approaches to simulating the noncommunicable disease control system are considered.

Objective. To develop and scientifically substantiate the epidemiological standard definitions of cases of mastitis and infection at the site of episiotomy in puerperas. Materials and methods. The signs characterizing the clinical manifestations of infections and determining patient management tactics were investigated in the epidemiological analytical case-control study. 128 puerperas were followed up. Results. It was found that during active detection of mastitis in puerperas, there must be its signs, such as unilateral breast involvement, a body temperature of 37.5 °C or higher, a physician should prescribe antibiotics for its treatment. The criteria for infection identification at the site of episiotomy are prolonged edema at the site of suturing or active suture treatment with an antiseptic, by applying physiotherapeutic procedures to the suture site. Conclusion. The introduction of the developed standards into the activity of hospital epidemiologists allows one to optimize a system of epidemiological surveillance of pyoseptic infections.

Objective. To define the incidence of cerebral toxoplasmosis (CT) among all brain lesions in HIV-infected patients and its clinical and diagnostic criteria. Subjects and methods. 458 patients with Stage 4B HIV infection (AIDS) with central nervous system involvement were followed up for 7 years (2003-2009). The authors used cerebrospinal fluid microscopic and bacteriological assays for DNA of T. gondii, M. tuberculosis, herpes simplex virus (HSV) types 1 and 2, cytomegalovirus (CMV), HSV type 6, varicella-zoster virus, Cr. neoformans, C. albicans, C. glabrata, and C. krusei. Blood and CSF were tested for IgM and IgG T. gondii antibodies, by using the indirect immunofluorescence test and enzyme immunoassay; brain magnetic resonance imaging was carried out. Results. In patients with late-stage HIV infection, the principal cause of neurological diseases was CT (34.7% of brain lesion cases). In 11.5% of the patients, it ran as a generalized process involving the brain, lung, heart, liver, and eyes. There was commonly CT concurrent with CMV infection, as well as with tuberculosis and other secondary lesions. Conclusion. Of concern in the diagnosis of CT are magnetic resonance imaging data in addition to the major clinical evidence suggesting this diagnosis, rather than pathognomonic signs. T. gondii IgG at high and average serum concentrations is of diagnostic value, which may be used as an auxiliary method to confirm the diagnosis.

Objective. To study the oral mucosa (OM) in patients with yersiniosis. Subjects and methods. Dental examination covered 68 adult patients, including 38 with yersiniosis, 8 of them had it concurrent with salmonellosis (mixed infection), and 30 patients with Salmonella monoinfection). The patients’ mean age was 32.25 ± 0.93 years. A control group consisted of 30 patients without gastrointestinal pathology being recorded. Results. The dental examination of the patients with yersiniosis and mixed Yersinia and Salmonella infection revealed varying degrees of OM lesion. The study of the clinical features of gingivitis, glossitis, and stomatitis depending on the type of the pathogen indicated that OM lesion was most common in salmonellosis, more rarely in yersiniosis, and even more uncommonly in mixed infection. Comparison of changes in OM in yersiniosis and salmonellosis showed its severer involvement in the patients with salmonellosis. Conclusion. There is evidence that early diagnosis and treatment of the oral cavity organs should be made in the acute period of yersiniosis to prevent gingivitis from progressing to periodontitis.

Enfuvirtide (ENF) is the first and now only drug from a class of cellular HIV fusion inhibitors. The highest therapeutic effectiveness was obtained in patients with HIV infection resistant to a number of drugs when the antiretroviral therapy (ARVT) regimen included ENF in combination with agents from previously used classes, but having another spectrum of virus resistance mutations or in combination with new classes of antiretroviral drugs. The existing recommendations suggest that it is advisable to use ENF in patients who had received two or more ineffective therapy regimens. However, there is more and more increasing evidence for its use as a component of an ARVT regimen for some categories of HIV-infected patients. A rapider decrease in HIV RNA levels in patients taking ENF and a substantially more marked increase in the count of CD4 + lymphocytes permit the use of this drug in patients who had very low baseline CD4 + lymphocyte counts (< 50 cells/μl) and in those with comorbidity (HIV infection and tuberculosis). Physicians’ opinion about some difficulties in its intake and patients’ negative attitude towards agents to be injected is a common obstacle to the use of ENF. Comparative analysis of the opinions of physicians and patients on ENF revealed a discrepancy between the physician and patients in the perception of ENF use and showed that the patients had a more positive attitude towards the use of this drug than is expected by the physicians. About 90% of the patients appreciated their quality of life as excellent, very good, or good after 6 months of ENF treatment.

Objective. To preliminarily evaluate the efficacy and safety of tenofovir disoproxil furamate (TDF) clinically used in combination with lamivudine (3TC) as the nucleoside base of an antiretroviral therapy (ARVT) in Russia. Materials and methods. The results obtained at 24 weeks of therapy in 45 HIV-infected patients on the ARTV comprising the nucleoside base including RDF (Hetero Drugs Limited, India) in combination with 3TC were summarized. Efavirenz (EFV), lopinavir/ritonavir (LOV/r), ritonavir-boosted atazanavir (ATV/r), or raltegravir (RAL) was included as the third agent in the ARVTregimen. Nineteen patients (Group 1) had not received ARVT before and 26 patients (Group 2) had already been on other treatment regimens. The data were statistically processed using non-parametric methods. Results. Group 1 showed: a reduction in blood HIV RNA levels in all the patients (the undetectable level of this indicator was achieved in 26% of the patients after 4-week treatment, in 50% after 12 weeks, and in 72% of the those who had completed the study following 24 weeks; the level of below 1000 copies/ml was achieved in 58, 94, and 100% in these periods, respectively); a rise of 24-week treatment CD4 lymphocyte counts per 106 cells/μl versus the baseline and per 142 cells/μl versus the expected level in the natural history of the disease; an increase in 24-week treatment median blood platelet counts per 25 billion/l (from 154 to 179 billion/l), the minimal value rose from 26 to 109 billin/l. When switched to the regimens involving a combination of TDF and 3TC as the nucleoside base, Group 2 displayed: no increase in blood HIVRNA levels and maintenance of its previously achieved undetectable level; no decrease in CD4 lymphocyte counts (the recorded increase by 37cells/μl at 24 weeks of a new treatment regimen was statistically insignificant). There was no clinical progression of HIV infection or adverse reactions due to TDF use in both groups. Conclusion. 24-week ARV Tregimens including TDS + 3TC as the nucleoside base was efficacious and safe in both groups.

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