编号 3 (2013)

The rapid pace of urbanization and the modern development of public health in our country strongly pose a problem for us to neutralize, utilize, and bury medical waste, which is under current conditions considered as an important epidemiological and environmental component of national security. Since 2005, the amount of resulting medical waste in the Russian Federation has virtually tripled and amounted to over 1.8 million tons (about 1.5% of the total volume of production and consumption wastes). A significant portion (more than 30%) of medical waste is highly epidemiologically dangerous, poses a real risk for the prevalence of communicable diseases, and requires various approaches for their neutralization in terms of epidemiological and environment safety. By taking into account the progressive pace of modern health care development and the analysis of this problem in foreign countries, the amount of medical waste will increase progressively in the Russian Federation in the coming years. The important promising goals to solve this problem in the Russian Federation will be: to improve the legislative regulation of the problem; to elaborate federal, regional, and municipal targeted programs for safe centralized medical waste disposal in the large cities and regions of Russia; to carry out mandatory testing and examinations of new equipment and machinery for medical waste neutralization at special and accredited institutions; to license medical waste disposal activity; to make compulsory medical waste disposal education activity, by taking into consideration the current regulatory framework, international experience, and the current epidemic situation.

Tuberculosis (TB) continues to be a major health care problem in the whole country and in the RF areas supervised by the Central Research Institute of Tuberculosis, Russian Academy of Medical Sciences. In 2010—2011, there was a decrease in its incidence in 12 out of 15 regions of the Russian Federation. The incidence rate increased in three regions in 2011 compared to 2010. The TB mortality rate has fallen, but exceeded the average rate for the country (11.6 per 100 000 population) in 3 areas. The treatment effectiveness investigated in 3378 patients with pulmonary TB [Mycobacterium tuberculosis (MBT)+] varied from 76% in the Orel Region to 39.1% in the Ulyanovsk Region according to ceased bacterial excretion, as shown by microscopy, from 31.7% in the Ulyanovsk Region to 78.2% in the Orel Region according to sputum culture, and from 76% in the Orel Region to 36.4% in the Ulyanovsk Region according to cavity closure rates. The main reason for the low efficiency of treatment is its discontinuation and multidrug-resistant tuberculosis. To enhance treatment efficiency, it is essential to introduce rapid methods for MBT detection countrywide and to perform adequate treatment only with the drugs to which MBT is still susceptible.

Objective. To identify the genotypic profile and features of a virologic response to standard antiviral therapy (AVT) in patients with chronic hepatitis C (CHC) who belong to the indigenous and non-indigenous populations of the Republic of Kazakhstan. Subjects and methods. 221 patients aged 18 to 60 years with CHCfrom different regions of Kazakhstan were examined. Of them there were 143 ethnic Kazakh patients and 78 non-indigenous (Slavic) patients. Results. Equal proportions of genotypes 1b and non-1 (genotypes 2 and 3) of hepatitis C virus (HCV) were found among both the indigenous and non-indigenous populations of the Republic of Kazakhstan. With HCV genotype 1b in the Slavic group on AVT, the viral load declined more slowly than in the Kazakh group and was higher at weeks 4, 12, 24, and 36 of AVT. All the patients achieved a virologic response by the end of treatment. A sustained virologic response (SVR) was achieved in 85.0% of the Kazakhs and 71.6% of the Slavs. With HCV genotypes 2 and 3 in both groups on AVT, the viral load significantly decreased just by week 4 of treatment. In the ethnic Kazakh patients, the decrease was considerably higher. By the end of treatment (at week 24), both groups showed a viral load drop to an undetectable level. SVR was achieved in 87.5% of the indigenous patients and in 76.9% of the non-indigenous ones. Conclusion. HCV genotypes 1b and non-1 (genotypes 2 and 3) are detected with virtually equal frequency in patients with HCV in Kazakhstan. Kazakh ethnicity should be considered as a positive predictor of successful AVT in HCV patients.

Objective. To estimate the level of low- and medium-molecular-weight (LMW and MMW) substances and oligopeptides (OP) in the plasma, red blood cells, and urine of patients with erysipelas, as well as intoxication indices and coefficients in the dynamics of this disease. Subjects and methods. 112 patients with different forms of erysipelas were examined. The levels of LMW and MMW substances were measured by the method developed by M.Ya. Malakhova and modified by O.L. Grebneva et al. and the concentration of OP was estimated by that of O. N. Lowry in the plasma, red blood cells, and urine of the examinees. Results. There was a relationship of the indices under examination to the period and severity of the disease and the presence of comorbidities. The elevated levels of LMW and MMW substances and OP and redistribution between the body’s biological environments determine a change in the integral intoxication index and depend on the stage and degree of a pathological process. Conclusion. The determination of the indicators studied in erysipelas may serve as a marker of intoxication syndrome. They can be used as additional criteria for evaluating the severity of the process and the completeness of recovery.

The review gives the data available in the literature on the prevalence of pneumococcal infection in children worldwide. The efficiency of active immunization against pneumococcal infection is evaluated: its therapeutic, prophylactic, bacteriologic, and immunologic aspects are considered. Data on the social effectiveness of introducing mass pneumococcal vaccination programs for children in different countries are provided. The pharmacoeconomic effectiveness of universal vaccination for infants during the first years of life while implementing the program in Russia is predicted.

Objective. To study the effect of dicarbamin on the efficiency of antiviral therapy in patients with chronic hepatitis C (CHC) virus genotype 1b and decreased baseline leukocyte and neutrophil levels. Subjects and methods. Eighty-six patients were followed up, who were divided into 2 sex- and age-matched groups according to treatment regimens: Group 1 (n = 44) took pegylated interferon-a-2b (PegIFN-a-2b) + ribavirin; Group 2 (n = 42) received PegIFN-a-2b + ribavirin + dicarbamin. PegIFN-a-2b was injected subcutaneously in a dose of 100 μg once weekly, ribavirin was given in a dose of 1000 mg/day weekly as a 48-week course. In accordance with randomization (by the envelope method), dicarbamin was used in a dose of 100 mg once daily as a 9-weeks course following initiation of antiviral therapy, then 9 weeks before its termination. Results. It was found that the use of PegIFN-a-2b in combination with ribavirin (Group 1) caused a significantly more pronounced decrease in the indicators examined than in the group receiving dicarbamin (Group 2). Thus, in Group 1, the minimal level of leukocytes was 2.1 ± 0.16х10 9/1 and that of neutrophils was 1.0 ± 0.03 х 10 9/l whereas in Group 2, these were 3.4 ± 0.11 х 10 9/l and 1.9 ± 0.05х 10 9/l, respectively (p < 0.05). The analysis showed significantly better treatment results in Group 2 than in Group 1 (p < 0.05). It can be inferred that dicarbamin may potentiate an antiviral effect if incorporated in combination antiviral therapy. This emergent property of the drug was recorded when the long-term results of treatment were studied (a sustained virologic response was achieved). Conclusion. The use of dicarbamin in combination with PegIFN-a-2b and ribavirin in patients with CHC virus genotype 1b and leuko- and neutropenia at the start of therapy permits the treatment to be performed without dose reduction and PegIFN-a-2b discontinuation as there was no critical reduction in the levels of leukocytes and neutrophils. Incorporation of dicarbamin in combination antiviral therapy caused a rise in the rate of a sustained virologic response in patients with CHC, which increased the efficiency of treatment by 20.7%.