No 3 (2016)

Objective. To study the epidemiology of cancer in forensic medical practice and mortality from this disease on the basis of the analysis of forensic medical conclusions in Moscow. Materials and methods. The causes of cancer death were analyzed and compared with those given at the Russian Federation Federal State Statistics Service and the Moscow City Committee of State Statistics. The 2014 forensic autopsy findings in 769 cancer deaths were analyzed. Results. The epidemiological characteristics of cancers were given; the mortality rates were established from forensic autopsy results: the leaders were tumors of the respiratory organs (trachea, lung, and bronchus (46.0%), next were tumors of the gastrointestinal tract (17.7%) and female reproductive system (5.0%). Postmortem morphological verification of the neoplasms was performed in 11.2% of cases in 2014. Age and gender indicators and the histological forms of cancers were comparatively analyzed. Conclusion. In 2014 the proportion of cancers in the general mortality structure was found to be 12.1% in the Russian Federation and 11.1% in Moscow.

Objective. To estimate the situation associated with the spread of HIV subtypes, recombinant forms, and resistant variants in the Irkutsk Region. Material and methods. The paper gives the data of analyzing the nucleoside sequences of the HIV-1 pol gene encoding the enzymes: protease, reverse transcriptase, and integrase. The investigation used plasma from 65 HIV-infected patients residing in the Irkursk Region. Commercial test systems were employed to isolate RNA and reverse transcription-polymerase chain reaction and cyclic sequencing were carried out. Nucleotide sequences were detected by capillary electrophoresis in an automated molecular analyzer. Results. Phylogenetic analysis showed that 62 (95.38%) sequences were clustered with the HIV-1 genetic subtype A1 IDU-A variant, 2 samples were grouped with the recombinant form CRF02-AG, and one sample was with subtype B. Antiretroviral drug-resistant virus strains were detected in 63% of the patients. There was a broad spectrum of drug-resistant strains: those resistant to protease inhibitors in 10.77% of cases, nucleoside reverse transcriptase inhibitors in 58.46%, non-nucleoside reverse transcriptase inhibitors in 35.38%, and integrase inhibitors in 3.08%. The proportion of mono- and multidrug-resistant (to two or more drug) strains was 34.15 and 65.85%, respectively. Conclusion. In the Irkutsk Region, there is a predominance of HIV-1 subtype A1; the detection of other subtypes suggests that the population’s migration may increase. The spectrum of drug-resistant strains corresponds to the highly active antiretroviral therapy regimens that are most commonly used in our region.

Antiviral therapy for chronic hepatitis C has changed significantly in recent years. A regimen using pegylated interferon alpha-2a or alpha-2b and ribavirin has long been the gold standard of treatment. However, its low efficiency necessitates a search for more effective treatments. In 2014-2015, there was a breakthrough in the treatment of chronic hepatitis C, which was marked by the entry of just several direct-acting antiviral agents into the market. The advent of new drugs has opened up a possibility to perform shorter interferon-free therapy cycles and to enhance therapy efficiency to over 95%.

A number of factors, including human genome variability that determines the specific features of an immune response to virus entry and development in the body, influence a risk for and progression rate of HIV infection. The paper reviews studies of the genetic polymorphisms affecting the risk and progression rate of HIV infection, as well as their role in the development of opportunistic infections, including tuberculosis (TB). The studies of the role of genetic markers in patients with HIV/TB coinfection have provided evidence that a number of genetic polymorphisms affect the risk of developing active TB in patients with HIV without regard to other risk factors. However, the results obtained at this moment cannot be used in clinical practice to improve the diagnosis and prevention of TB in HIV-infected patients, because these require specification and further investigations on large patient samples and among representatives of different ethnic groups.

The article is devoted to cytomegalovirus infection (CMVI). Its urgency is caused by its widespread among infants and their high mortality rates. Currently, there is an increase in the incidence of this infection in all cauntries of the world. The interest in this problem is due not only to that newborns and infants in the first year of life may develop severe forms of this disease, but also they may be at risk of prognostically unfavorable consequences. Infants are infected in 30-50% of cases during their birth and postnatal period. This leads to acquired CMVI that may have various clinical manifestations: from local to generalized forms. In other cases the infection is transmissible via the airborne or contact routes when the children attend kindergartens or contact their elder siblings. What is more, CMVI frequently mimics other diseases, which makes its diagnosis and treatment difficult. Recent studies unveil the variants of adaptive immune responses in children with CMVI. The article presents the current view of CMVI and its various clinical manifestations and considers basic methods for the laboratory diagnosis of CMVI at the present stage. The authors of the article do not touch upon the issues of treatment of this infection. A detailed knowledge of the role of CMVI in developing multiple organ dysfunction will be able to assess many known diseases in a new way in order to improve their diagnosis and therapy.

Postvaccination histories were investigated in patients aged 3 to 8 years who had received a pentavalent vaccine containing an acellular pertussis component or a trivalent vaccine against measles, parotiditis, and rubella. The findings suggest that there are low rates of systemic and local reactions to immunization when these vaccines are used. The paper also shows the results of a questionnaire survey in the children’s parents, which reflect their opinion on some aspects of vaccination.

The article describes the current paradigm of teaching epidemiology, demonstrates the up-to-date technologies, forms and methods used during an educational process at the Department of Epidemiology and Evidence-Based medicine, I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia. It presents the scientific activities of the Department, the results of a students’ scientific circle. It is shown that the training of epidemiologists should focus on the formation of professional competencies required for future professional activities at the bodies and institutions of the Russian Federal Service for Supervision of Consumer Rights Protection and Human Welfare and the Ministry of Health.