No 4 (2014)

The elimination of infectious and parasitic diseases is discussed by the international medical community from time to time. At the same time the continuity of concepts inevitably loses and a new terminology associated with this theme is initiated at each new stage. The paper considers trends in research and practice communities’ attitude to the idea of eliminating infections, as well as the role of Russian scientists in the development of the above problem. It shows that not only and no so much vaccines, but also other preventive and antiepidemic measures may eliminate only controlled infection and may be a tool to control an epidemic process. A list of infections and invasions which may be theoretically eliminated by available means is given.

The paper presents the basic legislative acts that regulate activities in the compulsory health insurance (CHI) system in the Russian Federation, as well as advances in this field in the Voronezh Region in the past two decades. It also gives the results of the measures implemented in 2013 to protect the rights of those insured by the Regional CHІ Foundation of the Voronezh Region, which suggest that the introduction of the new legislation in the CHІ system has contributed to more intensive activities of providing free good-quality healthcare to the Russian Federation’s citizens living in the Voronezh Region, to higher awareness among the population, and to studies of the insured persons’ satisfaction with the quality of rendered medical services.

Objective. To identify leading risk factors for brucellosis transmission among the population of the Republic of Tajikistan because until the present there has been no scientifically grounded evidence for this problem. Materials and methods. The investigation was performed through a case-control study at infectious diseases hospitals. Results. Assisting animals during abortion (OR = 14.2) and delivery (OR = 6.4) was found to be a dominating risk factorfor Brucella infection. Its risk factors are the consumption of raw milk (OR = 2.6), undercooked meat and meat products (OR = 2.8) and the cleaning of a stall (OR = 2.3). Stock-keeping in private farms (OR = 1.7) and dung brick fuel preparation (OR = 1.86) may be a risk factor for Brucella infection. Conclusion. It may be concluded with a high degree of probability that in the Republic of Tajikistan brucellosis is transmitted in a mixed way (by a contact or foodborne route), the contact route of transmission being prevalent.

Objective. To study the relationship of the antioxidant system to intoxication syndrome in patients with chronic hepatitis c (chc). Materials and methods. One hundred and twenty-eight patients aged 19 to 45 years with CHC and 20 apparently healthy individuals without markers for hepatitis were examined. According to the state of the antioxidant system, the patients were divided into 3 groups. The antioxidant system was determined by the level of the activity of glutathione and glutathione-dependent enzymes, such as glutathione peroxidase, glutathione reductase, and glutathione transferase. Results. The investigation has shown that as intoxication increases, the examined patients with CHC are observed to have significantly lower levels of total glutathione and its oxidized and reduced forms. Out of the glutathione-dependent enzymes, glutathione peroxidase is most related to intoxication syndrome: the lower the enzyme activity, the more marked intoxication in the patient. Conclusion. The degree of changes in the antioxidant system is related to the intensity of intoxication syndrome in patients with CHC.

The article highlights the problems of current antiviral therapy for chronic hepatitis C (CHC). The efficacy of combination therapy with pegylated interferon and ribavirin in patients infected with virus genotype l is not more than 50%. Incorporation of the hepatitis C virus protease inhibitors telaprevir and boceprevir increases sustained virological response in primary patients with CHC genotype l, but this therapy is expensive and accompanied by more serious complications. Because of its high cost, the therapy is inaccessible to a large group of patients in the Russian Federation. The given paper analyzes the results of clinical trials of the Russian recombinant IL-1β in the combined antiviral therapy of CHC.

The treatment of patients with resistant HIV is a complex problem requiring the use of nonstandard antiretroviral therapy (ARVT) regimens, an individual regimen for observation by an interdisciplinary team of specialists, and more frequent clinical and laboratory monitoring. Objective. To evaluate the efficiency and tolerability of a ritonavir and etravirine (ETR) (intelens ®)-boosted darunavir (prezista ®) regimen in a patient who previously received ARVT and developed antiretroviral drug (ARVD)-resistance in HIV and had low adherence to therapy. Materials and methods. A clinical case of HIV infection with developed ARVT resistance with low therapy adherence was described. Results. The HIVARVD (Moscow) resistance test established susceptibility to two ARVDs: DRV/r and ETR. When the optimized ARVT regimen was used, the level of CD4+-lymphocytes in the patient was 4 cells/ßl (1%) and the viral load was 228 765 copies/ml. Three weeks after the use of DRV/r in a dose of600/100 mg and ETR 200 mg bid, there were positive virological and immunological changes: the viral load decreased to 9108 copies/ml and CD4+-lymphocyte counts were increased by 80 cells/ßl of the baseline level. The therapy was well tolerated. There were no adverse reactions. There was an improvement in blood indicators (Hb, 113 g/l; red blood cells, 3.2 x 10 12/l; white Blood cells, 4.8 x 10 9/l) and normalization of the levels of liver transaminases (ALT, 41 U/l; AST, 59 U/l). At the 1-year follow-up (April 2014), positive changes remained: the patent felt satisfactory, had no complaints, and gained 14 kg. CD4 +-lymphocyte count was 180 cells/μl (9%) and the viral load was not detectable (less than 50 copies/ml). Conclusion. To create conditions for the systematic use of ARVDs is a necessary factor for the effective treatment for HIV infection in injection narcotic drug users. The optimized ARVT regimen made in terms of the HIVARVD resistance test demonstrated its high efficiency, safety, and ease-to-use in the patient who had a low ARVT adherence at Baseline.