No 3 (2014)

Objective. To determine the frequency of bacteremias, the spectrum of their pathogens, and mortality rates among patients following cardiac surgery. Subjects and methods. Bacteremias after 8292 cardiac operations made over 13 years from 2000 to 2012 were retrospectively analyzed. The pathogens of bacteremia were identified using the BD Crystal panels and the BBL Crystal MIND database; microbial susceptibility to antibiotics was determined by the disk diffusion method in accordance with the NCCLS standards (USA). Results. The frequency of bacteremia decreased during the study period from 6.8% in 2000-2004 to 3.6% in 2010-2012. Bacteremias constituted the bulk (77.8-80.4%) of postoperative infectious complications (PIC). The frequency of isolation of gram-positive and gram-negative microbes and the severity of PIC were characterized. In bacteremias, the blood spectrum showed a preponderance of coagulase-negative staphylococci with the overall predominance of the gram-positive microflora. Its resistance to beta-lactam antibiotics and the multiple resistance of nonfermenting microbes to antibodies, except for polymyxin, tygacil, cefepin, and sulperazol, were noted.

Objective. To assess the clinical value and pathogenetic significance of herpesviruses in the development of longterm subfebrility in children. Subjects and methods. One hundred and twenty-seven children aged 6 months to 15years with long-term (3-week to 48-month) subfebrility were followed up. The children were admitted to the infection wards of the Central Clinical Hospital, the Morozov Children's Clinical Hospital, and the Russian Children's Clinical Hospital (Moscow). Results. Herpesvirus infection (HVI) markers were revealed in 112 (88.2%) children. Ofthem, 7(6.3%), 34 (30.4%), and 71 (63.3%) children were diagnosed as having acute, reactivated, and latent HVI, respectively. Conclusion. The clinical syndrome of long-term subfebrility should be considered to be one of the symptoms of an infectious disease running as a latent persistent process, less frequently as an active one.

Objective. To reveal the clinical and morphological features of tuberculosis in late-stage HIV infection. Subjects and methods. Based on the study of the clinical, radiological, bacteriological, and morphological data, the authors analyzed the causes of death in 74 patients divided into 2 groups: 1) 46 patients with confection (tuberculosis concurrent with HIV infection) (a study group) and 2) 28patients with monoinfection (tuberculosis) (a comparison group). Results. Examinations established that the process became particularly severe in patients with pulmonary tuberculosis concurrent with HIV infection mainly in stages 4B and 5. By taking into account the fact that 90% of the patients were admitted to hospital with a terminal stage of illness when a tuberculous granulomatous reaction had not just developed as a means of specific antituberculosis defense, the evolution of the process was characterized by acute generalized lymphohematogenic and hematogenic dissemination with simultaneous damage to many organs (meninges, lung, liver, spleen, adrenals, pancreas, heart, mesenteric lymph nodes). At the same time, the comparison group patients developed isolated lung lesions as tuberculous granuloma without involvement of other organs into the process. Conclusion. The patients with late-stage (4B and 5) coinfection and considerably lower CD4+- lymphocyte counts are not prone to developing tuberculous granuloma. This period shows a predominance of acute generalized lymphohematogenic dissemination with concurrent damage to a few organs. The specific process is chiefly present as focal or total caseous necrosis.

The current epidemiological, clinical and economic aspects of the treatment and prevention of parenteral hepatitis B and C are analyzed. The paper provides the results of calculations of economic losses differentiated by disease severity and individual measures implemented by a patient during his/her treatment for this group of diseases. Current approaches to therapy should make allowance for the role of viral load in the progression of the disease and in the development of liver cirrhosis and hepatocellular carcinoma and the efficiency of treatment and its cost in relation to the stage of hepatitis B and its complications. There are data on both the cost of treatment depending on its chosen regimen with due regard for the use of new drugs recently introduced into clinical practice and on the clinical and economic efficiency of population immunization.

The need to study the relationships of clinical and laboratory parameters in infectious diseases remains relevant until now. To standardize basic methods for examination of patients with any disease is one of the leading health problems of practical healthcare. In this respect, the proposed algorithm (a human biochemical passport) is the scientific result of a systems approach to interpreting laboratory data. Such studies do not entail any additional equipment at the profile specialized medical institutions, which particularly emphasizes the high practical importance and ease of introducing the new procedure.

Lipodystrophy syndrome encompasses clinical symptoms, such as lipoatrophy and excess adipose tissue accumulation in the selective parts of the body, as well as laboratory symptoms appearing mainly as lipid metabolic disturbances. The risk of lipodystrophy syndrome in HIV-positive patients depends on the patient's age and premorbidity, immunosuppression levels, a combination of antiretroviral drugs. The manifestations of lipoatrophy are most frequently observed in the use of thymidine nucleoside analogues and dyslipidemia is most common in that of HIV protease inhibitors. Minimal impact on lipid profile is noted when administering lamivudine, abacavir, emtricitabine, tenofovir, nevirapine, atazanavir, maraviroc, and raltegravir. The association of metabolic disturbances with the development of cardiovascular diseases substantiates the need for their prevention and correction. This is served by the correct choice of drugs in terms of the patient's premorbidity, the clinical and laboratory monitoring of patients receiving highly active antiretroviral therapy with the timely correction of detected metabolic abnormalities. Statins, fibrates, niacin, and metformin are recommended as agents that correct metabolic changes.