№ 3 (2018)

The paper analyzes theoretical generalizations in epidemiology in the period after great bacteriological discoveries. It characterizes the most important theoretical generalizations in the twentieth century and shows the role of Russian scientists in their formulation. The concepts and theoretical generalizations in modern-day epidemiology are presented. Problems are revealed and areas are proposed for further investigations in the theory and practice of epidemiology.

Results. There was an annual rise in the number of MenW cases, a prevalence of older age patients over young pediatric ones, and a high mortality rate. Conclusion. With the continued increase in the number of MenW cases and in the availability of a safe and effective vaccine, a decision must be made to increase vaccination against meningococcal infection to prevent further increases in its incidence rates. Results. There was an annual rise in the number of MenW cases, a prevalence of older age patients over young pediatric ones, and a high mortality rate. Conclusion. With the continued increase in the number of MenW cases and in the availability of a safe and effective vaccine, a decision must be made to increase vaccination against meningococcal infection to prevent further increases in its incidence rates.

Objective. To assess the incidence, risk factors, and adverse outcome of nosocomial pneumonia (NP) and the prevalence of resistant pathogens. Subjects and methods. A total of 700 medical histories of patients in the Departments of Surgery and Therapy of the hospital over 2014-2015 were retrospectively analyzed. Clinical factors, the peculiarities of a surgical intervention, the risk of unfavorable outcome, and microbiological results were analyzed. Statistical analysis was carried out using the R 3.3.2 language. Results. The incidence of NP was 17.1% (n = 120). The adverse outcome was significantly influenced by the presence of cancers (53%; p = 0.003), tracheostomy (60%; p = 6.9e-11), and the duration of mechanical ventilation (p = 4.9e-08). The prognosis was not affected by body mass index (27.0±4.7 versus 26.8 ± 5.7; p = 0.88). There was a preponderance of gram-negative flora: Ac. baumanii Carb+ 15 (31.3%), Klebsiella pneumoniae ESBL 12 (25.0%), Klebsiella pneumoniae Carb+ 6 (12.5%), and Pseudomonas aeruginosa Carb+ 10 (20.8%). Conclusion. The highest incidence of NP is noted in the departments of cancer and cardiac surgery; the risk factors for adverse outcome are cancers and the duration of mechanical ventilation.

Objective. To study the epidemiological, clinical, and diagnostic aspects of tuberculosis (TB) concurrent with HIV infection in the Republic of Guinea. Subjects and methods. A total of 646 patients with lung diseases partially associated with HIV infection were examined in the healthcare facilities of Kindia, Dubreka, and Conakry (Republic of Guinea). Pulmonary TB was diagnosed by microscopy, culture, and X-ray study. The patients’ blood HIV antibodies were determined by an enzyme immunoassay and confirmed by Western blotting. The epidemiological, clinical, and diagnostic aspects of these concomitant diseases were assessed. Results. Pulmonary TB was diagnosed in 200 patients. It was found that there were HIV-1 (80%), HIV-2 (15%), and HIV-3 (5%) strains. The proportion of patients with HIV infection concurrent with TB in the healthcare facilities was 50% in Kindia, 17.2% in Dubreka, and 15.7% in Conakry. Among the patients there were slightly more women, the latter (housewives) prevailed among 11 social and professional groups of patients. Persons aged 15-44 years are at the greatest risk of infection. The patients had typical clinical signs of TB. X-rays revealed a predominant shadow of the lung base (40%). Among concomitant diseases, tropical malaria (69.4%) and intestinal parasitoses (40%) were predominant in TB patients at the Conakry hospital. Among opportunistic infections, there was anemia (92.4%), candidiasis of the gastrointestinal tract (61.2%), dermatosis (3.5%), toxoplasmosis (3.5%), and Kaposi’s sarcoma (2.3%). Conclusion. Since the classical techniques for TB diagnosis are laborious, low-sensitive, and insufficiently specific, modern PCR diagnostic methods are most promising. But they are still unavailable in the country due to their high cost and a lack of trained of medical staff. In the future, the Research Institute of Applied Biology of the Republic of Guinea (RIABG) will master the new test systems developed in the State Research Center for Applied Microbiology and Biotechnology (Obolensk, Russia); all the more so as the RIABG employees have already undergone the training organized by the Federal Service for Supervision of Consumer Rights Protection and Human Well-Being of the Russian Federation. Genotyping of Mycobacterium tuberculosis isolates is scheduled, which will improve the quality of diagnosis of TB as a concomitant disease in HIV infection, as well as treatment regimens and TB epidemic surveillance in the Republic of Guinea.

Objective. To investigate the antimycotic activity of the probiotic strain Bacillus subtilis 534 in the in vitro cultivation conditions. Materials and methods. The taxonomic identification of the isolated pathogenic fungi and their antimycotic sensitivity/resistance determined on an automated MicroScan WalkAway-96 plus System. The strain B. subtilis 534 was grown under submerged cultivation conditions. The antimycotic activity of the culture liquid was determined by the agar diffusion assay. Thirty-six clinical isolates of the pathogenic fungi Candida albicans, C. catenulata, C. glabrata, C. krusei, C. lusitaniae, C. parapsilosis, С. tropicalis, Cryptococcus neoformans, and Trichosporon spp. and the algae Prototheca spp. were used as tests for the determination of their antimycotic activity. Results. The clinical isolates differ in resistance/sensitivity to the antimycotics amphotericin, miconazole, ketoconazole, itraconazole, and fluconazole, whereas 10 isolates are resistant to all five of these drugs. Thirty-four out of the 36 clinical isolates are sensitive to the culture liquid of the strain B. subtilis 534 and to its isolated active components. Presumably, strain 534 in the human intestine also forms antimicrobial compounds that are active against pathogenic fungi, which is responsible for its antimycotic efficacy. Conclusion. The long-term medical application of the probiotic sporobacterin that is B. subtilis 534 spore suspension suggests that the latter is effective and free of side effects.

It is necessary to regularly assess the possibility of switching to a new regimen reducing the risk of toxicity, to simplify antiretroviral therapy (ART), to facilitate medication adherence, and to enhance the efficiency of treatment in HIV-infected children with achieved suppression on current ART. When there is a need for lifetime therapy, the toxicity of ART is at the forefront. Numerous studies have revealed that metabolic disorders occur in 26-65% of children and are not dependent upon either the duration of ART or the age of a child. Along with high efficiency, therapy adherence is also important for children: daily single-tablet regimens are of undoubted benefit since they increase the adherence by 15-25% compared to the separate use of drugs. The rilpivirine/tenofovir/emtricitabine (RPV/TDF/FTC) single-tablet regimen used in HIV-infected adolescents is accompanied by sustained virological suppression and improved metabolic status. Metabolically favorable regimens with the minimum multiplicity and frequency of drug use should be chosen for HIV-infected children and adolescents throughout treatment in order to achieve its high efficiency, adherence, and safety.

Objective. To investigate the risk of increased antibiotic resistance to improve the quality of medical care, by rationalizing the use of antibiotics in head and neck surgery hospitals. Materials and methods. The authors carried out a retrospective analysis of the consumption of antimicrobial drugs (AMDs) in a head and neck surgery during 2016 and investigated their consumption, by using the prospective audit strategy with an interventional component and feedback. Results. Ceftriaxone is traditionally prescribed for the treatment of pyoinflammatory processes and perioperative antibiotic prophylaxis (PAP). The introduction of the prospective audit strategy has changed physicians’ stereotype in the prevention of PAP. The formation of a reserve of AMDs and transport nutrient media has ensured timely blood collection for bacteriological examination, as well as adequate antibiotic therapy just in the first hour after diagnosis at any time. Conclusion. The prospective audit strategy with an interventional component and feedback contributes to the rational use of AMDs. The formation of a reserve of antibiotics and transport media can apply a de-escalation approach to treating severe infections and improving the quality of medical care.