The use of computer techniques to optimize the diagnosis of tuberculosis in HIV-infected patients at the secondary diseases stage

Вackground: The course of tuberculosis in HIV-infected patients has no significant clinical and diagnostic differences from damage to organs and systems of other etiology. The growth of new cases of HIV / TB co-infection necessitates a revision of diagnostic approaches, their improvement in order to increase the efficiency of examination and management of HIV-infected patients, depending on the stage and indicators of the immune status. The aim of the study was to determine by the method of complex statistical processing the main clinical and laboratory-instrumental criteria for improving the diagnosis of tuberculosis in HIV-infected patients at the stage of secondary diseases. Methods: The study design was retrospective. The object of the research was the case histories of 113 patients with HIV infection at the stage of secondary diseases (classification by V.I. Methods of parametric and nonparametric statistics, computer analysis of images with the gradient program proposed by Dr. Sci. A.N. Gerasimov, to assess the possibility of using micro- and macro-preparations of tissues and organs of patients with HIV infection. Results: Using the method of correlation adaptometry, it was found that there are no significant differences in the clinical course of HIV-infected patients with tuberculosis of various localization, and with lesions of the respiratory organs of other etiology. The use of multivariate probability models made it possible to identify significant diagnostic risk factors for lethal outcome - 66.7% of patients with further lethal outcome complained of chest pain during breathing (p = 0.004), and ESR was significantly accelerated in patients with a lethal outcome in the hospital 77 1.99 (p = 0.019). Conclusion: The multicomplex instrumental and laboratory examination makes it possible to diagnose tuberculosis of various localization at the initial stage of development. The use of computer techniques optimizes and unifies the diagnostic search in patients with HIV infection and determines the timely treatment tactics

EPIDEMIOLOGICAL FEATURES OF HEPATITIS B IN THE RUSSIAN ARCTIC

Aim. To determine the epidemiological features of the hepatitis B in the Russian Arctic. Materials and methods. We carried out a retrospective analysis of the incidence of hepatitis B (acute and chronic forms) in 9 Russian Arctic regions, 3 subarctic regions (Khanty-Mansiysk Autonomous Okrug, Magadan Region, Kamchatka Territory) and Russian Federation in 1999-2019. We also studied the prevalence of chronic hepatitis B and vaccination data against hepatitis B in these territories. Results. From 1999 to 2019 the incidence of acute hepatitis B in three subarctic regions decreased 166 times (from 66.5 to 0.4 per 100 thousand population), in the Arctic zone of 73 times (from 29.8 to 0.4 per 100 thousand population) and 77 times in Russia (from 43.8 to 0.6). The incidence of chronic hepatitis forms in the same period in the Arctic zone decreased by 16.3 times (from 140.1 to 16.3), 5.8 times in the subarctic regions (from 116.6 to 20.0) and 5.7 times in Russia (from 96.3 to 16.8). In 2018, the results of the prevalence of chronic hepatitis B in the Arctic zone (697.3) was higher than in Russia by 98% (352.1) and higher than in the subarctic regions by 67% (588.6). Timely coverage of hepatitis vaccination in children aged 12 months in the Russian Federation, the Arctic zone and the subarctic regions is maintained at a high level (more than 90%) from 2004 in 2019. Coverage of children by vaccination to 17 years inclusive and adults up to 35 years on these territories also exceeded 90%. Conclusion. Vaccination against hepatitis B in the Russian Federation led to a significant decrease in the incidence of this infection in the Russian Arctic. High prevalence of infection indicates the need to continue the program of mass vaccination and the timely introduction of the first dose of vaccine newborns. To reduce the risk of cirrhosis and liver cancer, it is necessary to increase the availability of diagnosis of the disease and its possible outcomes in the Arctic regions and timely provision of antiviral treatment of all patients.

Possibilities of modern methods of laboratory diagnostics in the study of viral hepatitis A.

It is generally accepted that the course of viral hepatitis A is accompanied by short-term viremia, and the disease itself does not have serious consequences for the person who has recovered. The article describes a clinical case of a protracted course of viral hepatitis A with long-term persistence of the virus. Against the background of the therapy, the patient's condition improved, and by the time of discharge from the hospital on the 38th day of illness and later, with a retrospective examination on the 68th day from the onset of the disease by the method of reverse transcription PCR (RT-PCR in real time), the presence of RNA of the hepatitis A virus was confirmed in feces, which indicated a long persistence of the virus in the body. This observation indicates the need for long-term dispensary observation of patients who have undergone viral hepatitis A.

Practical remarks on hydrophobia (Rabies): publication of Enegolm, Medical Doctor, State Counselor and Chevalier of Russian Empire (1811)

Rabies, an outdated name for hydrophobia, has been known since ancient times, and even then its occurrence was associated with the bites of dogs and wolves. The only way to prevent the development of this disease was considered to be cauterization of the wound to destroy the poison contained in the saliva of an animal stricken with rabies. The article of the doctor, the actual state councilor Enegolm "Practical remarks on hydrophobia" published in No. 1 of the General Journal of Medical Science for 1811, really contains a detailed description of all the approaches to the treatment of hydrophobia that existed then, although, as the author notes, without any benefit. Nevertheless, even today, in the 21st century, the article is of great interest to doctors, since in the most detailed way, very emotionally, with empathy for the patient, he describes day by day the development of the clinical picture of the disease, forgotten by many modern doctors. The article contains recommendations for preventing the spread of rabies both in urban and rural areas, which does not lose its relevance today, given the problems associated with the widespread growth of the population of stray animals, in particular dogs and cats.

Intestinal helminths of dogs in Samarkand and the Samarkand region and their epidemiological significance.

Aims: To study the intestinal helminth fauna of domestic and neglected dogs living in the city of Samarkand and adjacent areas of the Samarkand region and to assess their epidemiological significance. Materials and methods: 112 dogs of different ages from Samarkand and the surrounding area were examined. 45 animals were examined by the method of incomplete helminthological autopsy; diagnostic deworming was performed in 12 priotarny dogs; in 55 dogs, feces were examined once by the Fulleborn method. Results: In the examined dogs, 4 types of cestodes and 4 types of nematodes were found in the intestines. The most common type was dog tapeworm (Dipylidium caninum). The extent of invasion (EI) is 73.7%, the intensity of invasion (AI) is 5-56 copies. Taenia hydatigena tapeworm was detected during preventive deworming in 5 animals out of 12 (41.7%), and at autopsy in 18 dogs out of 45 (40%), AI 1-4 copies. The tapeworm of Echinicoccus granulosus was found in the autopsy of one dog out of 45 (EI-4.4%, AI-more than 350 copies). Mesocestoides lineatus cestodes were observed in the autopsy of 3 dogs (EI-6.7%, AI-1-2 copies). Trichuris (=Trichocephalus) vulpis lived in the caecum of 20 dissected animals (EI-88%, AI-5-23 copies). During coproscopy of feces of 55 dogs, whipworm eggs were found in 25 animals (45.5%). Males and females of Toxocara canis were found in the intestines during autopsy of 5 animals (EI -22%, AI-2-4 copies). Eggs Toxocara coproscopy found in the feces of dogs 9 out of 55 (16.4 percent). The EI of the nematode Toxascaris leonina averaged 14.0%. AI 1-3 copies. The nematode Pterygodermatites (=Rictularia) affinis was found in the singular (male) in the duodenum of one dissected dog. Conclusions: In domestic and neglected dogs living in the territory of Samarkand and the Samarkand region, it was possible to establish the presence of 8 species of intestinal helminths, of which three species are dangerous to humans and have important epidemiological significance: Echinicoccus granulosus, Dipylidium caninum and Toxocara canis.

The autochthonous cases of acute opisthorchiasis in the Moscow region

Acute stages of parasitic diseases are rare diagnosed and therefore, clinicians have limited knowledge of their clinical features. We describe five autochtnonous acute cases of opisthorchiasis in Moscow region acquired from eating raw ides (L. idus). The most frequent clinical symptoms were febrile, eosinophilic syndrome with cholestasis. The patients were positive for IgG antibodies to O.felineus . Eggs of O.felineus were found in one patient. As egg production O.felineus starts 1 month after exposure and opisthorchiasis cases in Moscow region have low numbers of worms, the sensitivity of microscopy is low. Therefore we consider opisthorchiasis in all patients of unexplained acute fever, pain in upper right abdominal quadrant, and eosinophilia with cholestasis, when patients confirm the ingestion of raw fish. We recommend one day of praziquantel 25 mg/kg TID to patients infected with O.felineus. In previous publications describing the autochtnonous cases of opisthorchiasis in Moscow region the authors supposed that cases of local infection will be found again in Moscow region, and this is just a matter of time. The cases reported here confirm that this infection is endemic in Moscow region. The local people living close to rivers especially those who eat raw fish are at risk of infection O. felineus. There is a clear need to undertake special studies pertaining to the ways of promoting people living in Moscow region become aware of opisthorchiasis and to be motivated in preventive measures and treatment.

LIPID PEROXIDATION AND OXIDATIVE MODIFICATION OF PROTEINS IN THE PATHOGENESIS OF TICK-BORNE ENCEPHALITIS AND IXODIC TICK-BORNE BORRELIOSIS

Ixodic tick-borne borreliosis occupies a leading place among natural focal vector-borne infections in the Chelyabinsk region, and tick-borne encephalitis is less common. In the pathogenesis of the vast majority of diseases known to date, non-specific pathochemical processes are of the greatest importance. One of the most significant metabolic processes of this kind is free radical oxidation. Objective: to study the etiological structure and clinical features of tick-borne encephalitis and ixodic tick-borne borreliosis in comparison with the characteristics of the manifestations of oxidative stress in various clinical forms of tick-borne infections in the endemic region (for example, the Chelyabinsk region). Methods: Clinical studies were conducted on the basis of the Department of Infectious Diseases of the city Center of Neuroinfections, the 1st and 4th infectious departments of the MAUZ OZP GKB No. 8 in Chelyabinsk. The diagnosis of CE, ICB was established after a comprehensive clinical and laboratory study. The content of carbonyl products of oxidative modification of proteins was evaluated by their reaction with 2,4-dinitrophenylhydrazine (2,4-DNPH). In determining the content of primary and secondary products of lipid peroxidation, a method based on the phenomenon of rearrangement of double bonds into diene conjugates was used. Conclusions: The leading place among natural-focal vector-borne infections in the Chelyabinsk region is occupied by ICB, and CE is less common. The revealed changes in the study of oxidative stress in patients with CE and ICB not only indicate the prospects for developing new approaches to the pathogenetic therapy of tick-borne infections, involving the use of antioxidants in complex therapy, but also suggest a greater effectiveness of direct-acting lipophilic antioxidants that limit diene conjugation, and thereby prevent the accumulation of secondary cytotoxic products of lipid peroxidation.

Etiology of acute intestinal infections of viral character in the Altai territory

Background: The incidence of acute intestinal infections (ACI) remains at a high level every where, despite the ongoing medical and sanitary preventive measures. The significant progress made in the field of laboratory diagnostics allowed us to proceed to a detailed study of the etiological structure of AСI and as a result, it was found that in recent years the role of pathogens of viral nature has significantly increased, but a detailed study and characterization of these pathogens requires further research. Aims: to study the etiological structure and clinical and laboratory features of acute intestinal infections of viral etiology in adult patients in an infectious hospital. Materials and methods: The study included 181 patients, aged 18 to 76 years, who were on inpatient treatment in infectious diseases of "City hospital No. 5, Barnaul". The method of polymerase chain reaction (PCR) with hybridization-fluorescence detection "AmpliSens OKI screen-FL", bacteriological and serological (RIHA) methods were used for the diagnosis of acute intestinal infections. Results: In 108 patients (59.7%), the genetic materials of various pathogens of acute intestinal infections were detected. Of these, 54 (29.8%) patients had acute intestinal infection of viral etiology, including mono-infection in 45 people (83.3%) and caused by a combination of two viruses 9 people (16.7%); 41 (22.7%) patients had bacterial etiology, including a combination of two pathogens in 4 cases (2.2%) and 1 case with three pathogens; 13 patients with a combined viral bacterial intestinal infection and, in 73 patients the etiology was not established. The paper presents the epidemiological and clinical and laboratory features of acute intestinal infections of viral etiology. Conclusion: The data obtained indicate a trend in changes in the structure of acute intestinal infections, characterized by an increase in the proportion of viral intestinal infections (up to 50% in this study), which affects the choice of etiotropic and pathogenetic therapy. The results obtained demonstrate the effectiveness of the PCR method in the diagnosis of acute intestinal infections.

Semi-third-day fever in view of modern medicine

It is difficult for a modern doctor who relies on a wide range of laboratory diagnostic capabilities to imagine the path of mistakes, insights and delusions traveled by doctors of the past. How exactly through clinical observation the disease was observed. The archival article Half-tree-day fever published in the journal is an example of a clinical and epidemic description of an outbreak of an acute infectious disease, the etiology of which remains unknown. The more interesting are the distinguishing issues of differential diagnostics.

‘Semi-third-day fever’ according to special observations and experiments carried out in the southern countries of Russian Empire. Described by Dr. Iog Mart Minderer in 1770–1772

The article Semi-third-day fever is based on personal experience obtained during the hostilities in the southern regions of the Russian Empire in 17701772 by Doctor Ioannes Mart Minderer, Active State Councilor and companion, correspondent of various scientific societies, and member of the Imperial Medical and Surgical Academy. At first glance, the semi-third-day fever described by the author looks completely mysterious, but an attentive reader can solve this puzzle based on a detailed description of the course of the disease by days, clinical symptoms, course options, and most importantly, the climatic and geographical characteristics of the area, which is characterized by the spread of this disease, as well as based on own clinical experience and contemporary literature. The logical chain created by the author is of particular note, as it linked together the clinical presentation, geographical, climatic, and social conditions under which the disease considered develops, which is essentially a prelude to the formation of understanding of the role of environmental factors in the development and spread of various infections. Despite the archaic language of presentation, the article is percepted with great interest and is an example of a deep and comprehensive approach to the material analyzed.