No 3 (2017)

Objective. To evaluate the epidemiologic characteristics of parenteral viral hepatitides (PVH) and tuberculosis during long-term dynamic monitoring of morbidity. Materials and methods. The statistical data of the Moscow Regional Information Fund «The Center of Hygiene and Epidemiology in the City of Moscow» were used to analyze the incidence of PVH and tuberculosis in Moscow and the Russian Federation during the period 1999 to 2015. A total of 1,389 patient records and the data of 24 forms were processed. Results. The incidence of tuberculosis in the population of Moscow tended to increase in 1999 to 2009 and to decrease in 2009 to 2015. The incidence of tuberculosis in children, unlike that in the general population, grew continuously in 2003 to 2010 and peaked in 2010-2012. Its further decline may be due to improved diagnostic methods. When the incidence of acute forms of hepatitis decreases, that of chronic hepatitis B and C increases. The age structure of patients changed towards older ages. Hepatitides are 1.3-3.9 times more common in men than in women. A sexual contact remains a leading route of transmission of infectious agents. Conclusion. The current characteristics of the epidemic situation of hepatitis B and C and tuberculosis were revealed in Moscow and the Russian Federation.

Objective. To assess outpatient physicians’ compliance with clinical practice guidelines during prevention of recurrent myocardial infarction (MI). Materials and methods. A cross-sectional study was conducted in an outpatient clinic branch in Moscow. A total of 126 records of outpatients diagnosed with MI in the past 3 years (2012-2015) were analyzed. The compliance of drug therapy prescriptions with federal clinical practice guidelines was analyzed in patients with a history of recurrent MI developing 28 days after previous stroke and in those with no history of recurrent MIs. Results. The morbidity and mortality from coronary heart disease and acute MI remain at a high level in the Russian Federation. In the past 6 years, the mortality from recurrent MI has been more than twice that from single MI. An analysis of drug therapy prescriptions for patients with MI established their inconsistency with clinical practice guidelines for the prevention of the disease, as well as the low-level diagnosis of recurrent MI. An inadequate frequency of evidence IA drug uses and a very low frequency of percutaneous coronary intervention were identified. Conclusion. An inconsistency between invasive and drug therapy policies in the prevention of recurrent MI and a low-level diagnosis of the latter suggest that the outpatient physicians show a low compliance with the clinical practice guidelines for the prevention of MI.

Objective. To study military-aged men’s awareness of the modes of human immunodeficiency virus (HIV) transmission, the characteristics of a stigmatizing attitude towards HIV-infected people, and perception of a risk for infection. Materials and methods. The evaluation was conducted using a questionnaire survey in October-December 2016. A total of 509 men living in the Central Administrative District of Moscow were surveyed. The respondents’ age ranged from 17 to 26 years. The 18-year-old age group was represented as the most presented group (39.88%). The proportion of the survey participants under 20 years of age was 73.09%. Results. The proportion of military-aged men who correctly answered 3 questions, indicators about the modes of HIV transmission, was 25.54%. 60.11% of the respondents favored a condom in preventing HIV infection. 24.16% of the respondents agreed that mosquitoes transmitted HIV; 16.31% considered that HIV could be got from sharing the dish used by an infected person; and 54.43% deemed that HIV could be transmitted to a donor during blood donation. 72.55% of the respondents were against the human right to confidentiality of the diagnosis of HIV infection; 47.86% agreed that HIV-infected people led a mindless lifestyle; 44.8% did not agree to share a room with an HIV- infected person. Conclusion. The deficit awareness of the target group about HIV infection and the presence of a stigmatizing attitude towards and distorted ideas about the modes of HIV transmission are not conducive to adopting the forms of behavior that is less dangerous in regard to HIV infection. Lack of perception of the HIV infection-associated issues as individually significant ones is one of the obstacles to preventive work. Motivation for less dangerous behavior forms during brief preventive conversations, including in the format of counselling during HIV testing.

Objective. To analyze the incidence of acute hepatitis C (AHC) in the population of one of the typical megalopolises and their adjacent region in the period 1995-2015 and possible medium-term prognosis. Materials and methods. The official statistics on the incidence of AHC in Nizhny Novgorod and the Nizhny Novgorod Region was analyzed by comparison with that in the Russian Federation as a whole over the period 1995-2015. The paper gives the intensive and extensive morbidity rates in the adult population and children under 14 years of age. Results. The incidence rates of AHC in Nizhny Novgorod and the Nizhny Novgorod Region were 2.5-3.0 times lower than those in the Russian Federation, but had the same trends. The AHC incidence rate was progressively increased in 1995-2000. There were its ups and downs in 2001-2010. Overall, the incidence rates in the city and its region decreased by almost 14 times, these in the Russian Federation reduced by 10 times, amounting to 1.3 and 2.1 per 100,000population, respectively. In 2011-2015, there was no obvious continuous decrease in the incidence of AHC and its prognosis is uncertain. There may be a higher proportion of AHC in the structure of hepatitis morbidity. The incidence of AHC in children under 14 years of age was similar to that among the adult population, but its medium- term growth cannot be excluded. There was an adverse tendency to increase the proportion of children less than 14 years of age in the structure of AHC cases. Conclusion. This epidemiological study of the incidence of AHC suggests that there is significant progress in the organization of preventive care for the adult and pediatric populations of the Russian Federation; nevertheless, it causes some suspicion in the medium-term prediction of the situation, especially among the children.

Objective. To optimize approaches to preventing recurrent pointed condylomas (PC) of the external female genitalia after destructive therapy. Subjects and methods. A bicenter randomized open-label controlled comparative study was conducted. It included 93 patients with PC of the external genitalia, who were divided into 3 groups after CO2 laser destruction of PC. Group 1 (n = 31) received combined therapy with interferon-а (IEN-а) as rectal suppositories for 10 days in combination with oral indole-3-carbinol (I3C) tablets for 6 months. For the prevention of recurrent PC, Group 2 (n = 31) had only standard immunomodulatory therapy with IEN-а as rectal suppositories. A control group (n = 31) did not use pharmacotherapy. The investigators carried out photo fixation of PC and qualitative tests for human papillomavirus (HPV) by a PCR assay. Results. Six months after destruction, the PC recurrence rates were 6.5% in Group 1, 25.8% in Group 2, and 32.3% in the control group (p = 0.010). None of the groups were found to have recurrent PC at 12 months following treatment initiation. According to the data of HPV diagnosis (a common qualitative test), after the therapy within a 12-month follow-up, the viral elimination rates were 85.7% in Group 1, 66.66% in Group 2, and 54.54% in the control group. After 12 months of treatment initiation, the HPV types 6 and 11 elimination rates were 87.5% in Group 1, 85.7% in Group 2, and 75.0% in the control group. In these groups, HPV types 31 and 33 were eliminated in 83.3, 80, and 100% of cases, respectively. The high-risk HPV types 16 and 18 elimination rates were 100, 83.3, and 0%, respectively. Conclusion. There was a statistically significant reduction in the rate of recurrent PC of the external female genitalia, as well as HPV elimination and reduced reinfection especially with high-risk HPV types 16 and 18 during combined therapy with I3C and IFN-a. A combination of I3C and IFN-a showed a higher efficacy than the conventional use of IFN-a only.