Vol 79, No 4 (2004)

Editorial
Infectious diseases in Russia: problems and decisions
Maleev V.V., Pokrovsky V.I.
Abstract
Terapevticheskii arkhiv. 2004;79(4):5-9
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HIV-infection is spreading
Pokrovsky V.V.
Abstract
Terapevticheskii arkhiv. 2004;79(4):9-14
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Antiretroviral therapy of acute HIV-infection
Kravchenko A.V., Miroshnichenko A.V., Belyaeva V.V., Serebrovskaya L.V., Bogoslovskaya E.V., Sitdykova Y.R.
Abstract
Aim. To study efficacy of a short course of highly active antiretroviral therapy (HAART). Material and methods. Acute HIV infection was verified in 16 infected subjects basing either on seroconversion (by immunoblotting) or a documented negative result 6-12 months before registration of a positive result for HIV antibodies. Results. HAART was given to 12 patients (combivir+nevirapin). The number of CD+ lymphocytes (by median) 1 month after the treatment increased by 185 cells/mcl, 3 months after the treatment - by 215 cells/mcl. After 1-month therapy viral load (median) diminished by 2,02 logl0 copy/ml, after 3 months - by 2,31 logw copy/ml. 71% patients had HIV RNA under 400 copy/ml. Untreated patients showed changes neither in CD4+lymphocytes number nor in viral load. The study continues. Conclusion. HAART is used at the stage of acute infection in the presence of psychic trauma provoked by establishment of HIV-infection diagnosis. Therefore, it is necessary to consult the patients for preparing them for treatment and to maintain compliance.
Terapevticheskii arkhiv. 2004;79(4):15-18
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Secondary diseases in patients with HIV infection: 15-year follow-up
Ermak T.N., Kravchenko A.V., Gruzdev В.М.
Abstract
Aim. To analyse the results of a 15-year study of opportunistic diseases in AIDS patients. Material and methods. The spectrum of opportunistic diseases were made in AIDS patients in respect to clinical, laboratory and autopsy data for the periods: 1987-1992 (n = 27, 25 deaths-92.6%), 1993-1997 (n = 95, 58 deaths-61.8%), 1998-1999 (n = 70, 28 deaths-40%), 2000-2001 (n = 126, 31 deaths-24.6%), 2002 (n = 80, 32 deaths-40%). Results. The spectrum of opportunistic diseases in AIDS patients was determined for the above time ,:., periods and causes underlying these diseases have been determined. Conclusion. Among opportunistic diseases associated with HIV infections most prevalent were the fol-.;'.>'" lowing: tuberculosis, cytomegaloviral infections, cerebral toxoplasmosis. Leading modern trends were identified: increasing morbidity of AIDS, tuberculosis, new AIDS cases at late stages with severe opportunistic diseases (2/3 of deaths).
Terapevticheskii arkhiv. 2004;79(4):18-20
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Characteristics of tuberculosis running with HIV-infection
Schelkanova A.I., Kravchenko A.V.
Abstract
Aim. To analyse social, clinical, x-ray and immunological features of tuberculosis (ТВ) in 117 patients from the Moscow region with concurrent HIV-infection. Material and methods. The patients were divided into 3 groups depending on the time of ТВ and HIV-infection detection in relation to each other. Group 1 patients (20.5%) had suffered from ТВ for 2 years before detection of HIV-infection, group 2 patients (51%) were diagnosed simultaneously for 1-2 years to have both diseases, group 3 patients (28%) had suffered from HIV-infection for 2 years before the diagnosis of ТВ. Results. It was established that the course of ТВ with associated HIV-infection depends not only on severity of immunodeficiency caused by HIV but also on characteristics of M.tuberculosis and social status of the patients. Most of ТВ/HIV patients were drug addicts, alcoholicts, convicts. Unfavourable social status in the above patients, contact with ТВ (70%) and its realization in a penitentiary carry a high risk of drug-resistant ТВ. High prevalence of destructive ТВ forms (64%), among them large caverns were in 77%, may result from M. tuberculosis resistance to antituberculous drugs and unfavourable social status of the patients. Reduction of the number of CD4-cells lowers the ability to form caverns and fibrosis and promotes dissemination of M. tuberculosis bacteria with formation of inflammation foci in different organs and systems. Conclusion. Four clinical models of ТВ/HIV onset and course are suggested.
Terapevticheskii arkhiv. 2004;79(4):20-24
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Development and evaluation of the kit for detection of SARS-associated coronavirus RNA
Shipulin G.A., Yatsyshina S.В., Chulanov V.P., Markelov M.Y., Shipulina O.Y., Podkolzin А.Т., Astakhova T.S., Shishova A., Wuchun Cao -., Liu Wei -., Fan Baochang -.
Abstract
Aim. To develop a diagnostic kit for detection of SARS (severe acute respiratory syndrome)-related coronavirus RNA based on reverse transcription and polymerase chain reaction and to estimate its specificity and sensitivity. Material and methods. 68 virus and bacterial cultures, 240 clinical samples from people without SARS symptoms and also 22 RNA samples from patients with SARS symptoms received during the epidemic in Beijing were used. Results. The specificity of the kit was determined using animal coronaviruses and other bacterial and viral strains, causing acute respiratory and intestinal infections, and was shown to be 100%. The sensitivity of the kit in different clinical samples was 2.2' Iff genome equivalents of recombinant SARS RNA in I ml of the specimen. The kit was evaluated in the Institute of Microbiology and Epidemiology of Beijing (China) using SARS-cov viral suspension and clinical samples from patients with suspected SARS. It was shown that the kit was able to detect 10 TCID/50 ml of SARS-Cov virus. Testing of clinical samples from patients with suspected SARS showed that diagnostic sensitivity of the kit was 95%. Detection of the SARS-Cov RNA was more effective in feces compared to sputum 990 and 40%, respectively). Conclusion. The kit "AmpliSens SARS" for qualitative detection of SARS-related coronavirus RNA by reverse transcription and polymerase chain reaction (PCR) in nasopharyngeal wash/aspirates, naso/ oropharyngeal swabs, plasma, and extract from feces has been developed in the Central Research Institute for Epidemiology of the RF Ministry of Health. The kit contains reagents for RNA isolation and purification, cDNA synthesis by reverse transcription ofRNA, for PCR and for electrophoretic analysis of amplified products. The kit also contains recombinant positive and internal control samples allowing to control efficiency of analysis and showed good analytical and diagnostic characteristics.
Terapevticheskii arkhiv. 2004;79(4):25-30
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Present-day clinical characteristics of scarlatina
Pokrovsky V.I., Briko N.I., Malyshev N.A.
Abstract
Aim. To study present-day clinical manifestations of scarlatina. Material and methods. The authors have reviewed 138 case histories of children with scarlatina treated outpatiently and 51 case histories of hospitalized scarlatina children as well as social and age characteristics of 1657 children and 108 adults hospitalized in the infectious hospital N 1 in 19622001. Official data on scarlatina morbidity in Moscow and Russia for 1991-2001 are presented. Antibiotic sensitivity of 414 cultures of group A streptococci (GAS) isolated in 1987-1995 and 1996- 2001 was investigated. Results. Overall and seasonal scarlatina morbidities in 7- 14-year-olds appeared to rise significantly. In the majority of cases scarlatina took a mild course but in the adults clinical picture of the disease was rather severe. GAS demonstrated high sensitivity (about 100%) to betalactamic antibiotics. The percentage of erythromycin-resistant streptococcal cultures increased more than 9-fold and reached 1.9% (1996-2001). There is a marked trend to a proportional increase of GAS cultures resistant to tetracycline and gentamycin. Conclusion. Recently, changes have occurred in scarlatina epidemiological and clinical features. Different sensitivity of GAS to antibiotics must be taken into consideration for prescription of etiotropic treatment and prevention of scarlatina at jobs.
Terapevticheskii arkhiv. 2004;79(4):31-34
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Design of methods assessing efficacy of antirabic vaccine prophylaxis
Nedosekov V.V., Zhdanova N.A., Kurilchuk Y.N.
Abstract
Terapevticheskii arkhiv. 2004;79(4):34-36
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Diagnosis of structural changes of the brain in patients with coronary and asymptomatic carotid atherosclerosis
Astanina I.A., Dudko V.A., Vorozhtsova I.N., Lukyanenok P.I.
Abstract
Aim. To compare echomorphostructure of atherosclerotic plaques and vascular stenosis degree with structural changes of the brain according to MR image in patients with combined atherosclerotic affection of coronary and carotid arteries in an asymptomatic course of carotid atherosclerosis. Material and methods. MR imaging was made in 53 men aged 44 to 78 years with stenosing at herosclerotic affection of the internal carotid arteries. Vascular obstruction reached 30-80%. Neurological examination detected no signs of focal brain lesions. Hypertension, myocardial infarction, permanent atrial fibrillation were diagnosed in 19 (36%), 20 (38%) and 12 (23%) patients, respectively. Results. Ultrasound investigation has established that carotid arteries contain more frequently spongy and heterogenic plaques than dense and calcinated. MRI registered structural alterations of cerebral tissue of various degree in 96% cases. Conclusion. Significant correlations were established between ischemic affection of the brain with myocardial infarction, arterial hypertension, cardiac fibrillation, type of atherosclerotic plaque.
Terapevticheskii arkhiv. 2004;79(4):37-40
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Preclinical diagnosis of renal damage in essential hypertension
Grinstein Y.I., Shabalin V.V.
Abstract
Aim. To study renal functional reserve and 24-h beta2-microglobulinuria (B2-MGU)in patients with different stages of essential hypertension (EH) and to evaluate acceptability of these parameters as early markers of preclinical renal impairment in EH. Methods. We examined 150 patients (mean age 42.1 ± 3.4 years) with EH without overt clinical manifestations of hypertensive nephropathy. Renal functional reserve (RFR) was determined with the use of acute oral protein loading and was defined as an increase in endogenic creatinine clearance in percent. B2-MGU was evaluated by radioimmunoassay (RIO-BETA-2-M1CRO kit). Radioimmunoassay detection of microalbuminuria (MA U) was performed with the use of the standard kit Albumin-RIA. Results. RFR appeared to be significantly lower in patients with EH compared to the control group, and its level significantly decreased with aggravation of EH. Both B2-MGU and MAU were significantly higher in patients with EH and significantly increased with aggravation of EH. Conclusion. We suggest that, apart from MAU, RFR abnormalities and excessive B2-MGU should be used as markers of preclinical renal impairment in EH.
Terapevticheskii arkhiv. 2004;79(4):40-43
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The spectrum and activity of urinary Ig-proteinases as a marker of chronic pyelonephritis
Zinkevich О.D., Glushko Y.A., Safina N.A., Tyurin Y.A.
Abstract
Aim. To study the activity of Ig-splitting proteinases of various classes in the urine in patients with chronic pyelonephritis. Material and methods. Clinical, device and laboratory examinations were made in 50 patients (age 20-60 years). Admission and dynamic measurements were also made of the activity of serin, metal-dependent and thiol Ig-splitting proteinases in the urine. Results. Total proteolytic activity in the urine of the patients was higher than in healthy subjects. Thiol proteinase activity was detected in 98% cases. This activity was WO times higher in the patients than in healthy subjects. Significant differences were registered in the activity of serin proteinases. After the treatment the level of serin proteinases approached the normal value while thiol proteinase activity decreased significantly (2-fold, on the average) but remained high. If this activity was high, the patients (70%) had 1-2 exacerbations annually, in low activity exacerbations were absent. Conclusion. The activity of Ig-splitting proteinases of different classes is an important diagnostic and prognostic laboratory criterion of chronic pyelonephritis and can serve a criterion of treatment efficacy.
Terapevticheskii arkhiv. 2004;79(4):43-45
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Potentialities of high-resolution computed tomography in diagnosis of pulmonary lesions after bone marrow transplantation in blood diseases
Gotman L.N., Kostina I.E., Vishnevskaya E.S., Togonidze D.K., Mendeleeva L.P., Lyubimova L.S., Savchenko V.G.
Abstract
Aim. To study characteristics of a skialogical picture of pulmonary parenchyma and roentgenomorphological signs of inflammatory changes before and after bone marrow transplantation (BMT); relationship between the data of high-resolution computed tomography (HRCT) and clinical data. Material and methods. HRCT (computer tomograph of the third generation "Somatom CR-3") was made in fever, changes in physical examination in patients (n = 28) after BMTfrom November 200] to January 2003. BMT was made in myelomic disease, lymphogranulomatosis, acute leukemia, chronic myeloid leukemia, lymphosarcoma, autoimmune hemolytic anemia. Results. Twenty four patients were examined before BMT. Of them, 18 patients had roentgenomorphological changes of the parenchyma, primarily, diffuse. Three patients were examined during conditioning, two cases had signs of toxic pulmonitis. One day after allo-BMT all the patients exhibited lowering of densitometric values of pulmonary tissue by 70 HU vs the baseline. Infectious affection of the lungs was diagnosed in 13 cases during day 0-100. From day 100 after allo-BMT 7 recipients were observed. In 6 cases the changes resulted from transplant against host reaction. Infectious affection of pulmonary tissue was observed in 1 case. Characteristic x-ray picture of pulmonary stroma In secondary disease was determined. Conclusion. For early diagnosis of pneumonia in myelotoxic agranulocytosis it is necessary to make examination by HRCT before BMT. HRCT of the chest is indicated in even minor changes in the clinical picture. It is necessary to perform a control over water-electrolyte balance and active respiratory exercise in the course of conditioning. Viral pneumonias show the picture of metainflammatory changes for a long time. Fungal pneumonias tend to recurrence at "previous site". HRCT examination of the pulmonary tissue provides more information about pulmonary tissue in patients with secondary disease.
Terapevticheskii arkhiv. 2004;79(4):45-50
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Efficacy of the Rome criteria II in diagnosis of irritable bowel syndrome
Parfenov A.I., Ruchkina I.N., Orobei Y.A., Bykova S.V.
Abstract
Aim. To study efficacy of the Rome criteria II in diagnosis of irritable bowel syndrome (IBS). Material and methods. The examination was made of 288 consecutive patients with an IBS diagnosis admitted to the hospital from January to December 2002. Results. The IBS diagnosis was confirmed in the specialized hospital in 74 (25.8%) of 288 patients admitted with this diagnosis. Of 61 patients, whose diagnosis met the Rome criteria, the IBS diagnosis was not confirmed in 7patients (11.4%). Conclusion. Out of 288 patients admitted to a gastroenterological hospital, 78.8% patients were diagnosed at the prehospital stage not basing on the Rome criteria and appeared erroneous in 70.1%. The analysis of the anxiety causes identified different intestinal diseases in 78.5% cases, the diagnosis of IBS was confirmed in the rest cases. Specificity of the Rome criteria II was 88.6%, sensitivity 82.4%. This provides a reliable diagnosis of IBS.
Terapevticheskii arkhiv. 2004;79(4):51-54
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Exercise and nicotinic acid delayed action drug - enduracin: application in outpatient rehabilitation of patients with ischemic heart disease
Oganov R.G., Aronov D.M., Krasnitsky V.В., Perova N.V., Olferyev A.M., Smolensky A.V., Novikova N.K., Vygodin V.A.
Abstract
Aim. To evaluate efficacy of combined use of moderate exercise and nicotinic acid drug enduracin in patients with coronary heart disease (CHD) with moderate dyslipidemia (DE). Material and methods. The effects of exercise therapy alone, enduracin alone and their combination on physical performance (PP), hemodynamics, blood lipid spectrum and clinical course of CHD were studied in 93 CHD patients with moderate DE. The results were evaluated clinically after 1-year treatment. Results. Combined used of exercise and enduracin in CHD patients showed its efficacy manifesting in improvement of PP, hemodynamics at rest and exercise test, left ventricular systolic function, clinical course, reduction of DE. Enduracin+exercise appeared more efficient than their use in monotherapy. Enduracin monotherapy had a positive action on PP, arterial pressure and anginal attacks frequency. Conclusion. Enduracin is recommended as monotherapy and in combination with moderate exercise in outpatient rehabilitation and secondary prophylaxis of CHD patients with moderate dyslipidemia and angina pectoris to relieve myocardial ischemia under exercise, to raise PP, improve lipid composition of blood and prevent maladaptive left ventricular remodeling.
Terapevticheskii arkhiv. 2004;79(4):54-59
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Efficacy of a cytoprotector mexicor in urgent cardiology
Golikov A.P., Mikhin V.P., Polumiskov V.Y., Boitsov S.A., Bogoslovskaya E.N., Veselyeva N.V., Lukyanov M.M., Rudnev D.V., Frolov A.A.
Abstract
Aim. To study efficacy of cytoprotector mexicor in patients with unstable angina (UA), acute myocardial infarction (MI), hypertensive crises (HC) in combined therapy with conventional drugs. Material and methods. An open randomized study included 338 patients with acute forms of ischemic heart disease (IHD) and arterial hypertension running with crises. Combined therapy of 20 patients with UA, 90 patients with MI and 43 patients with HC (study groups) was supplemented with mexicor in a dose 6-9 mg/kg/day. The control matched patients (20, 86 and 79 patients, respectively) received conventional treatment alone. The effects of the treatments were assessed by ultrasound investigation of the heart in M-, B- and Doppler modes, by ECG and arterial pressure 24-h monitoring, by activity of lipid peroxidation (LPO). Results. Adjuvant therapy of urgent cardiological conditions with mexicor diminished oxidant stress, left ventricular dysfunction. In MI patients mexicor promoted reduction of the akinesia zones, recovery of disturbed segmentary contractility. In UA patients mexicor contributed to more pronounced decrease in the frequency, duration and severity of myocardial ischemia, enhanced stabilization of angina. In HC patients mexicor promoted earlier normalization of a 24-h AP profile and variability of cardiac rhythm, recurrence rate of HC decreased 2-fold. Conclusion. The addition of mexicor to conventional therapy of UA, MI, HC improves clinical course of these diseases, reduces oxidant stress, accelerates recovery of cardiac contractility and left ventricular diastolic function, normalization of central hemodynamics.
Terapevticheskii arkhiv. 2004;79(4):60-65
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Methodological approaches to estimation of a morning urge of arterial pressure in essential hypertensives
Lazareva N.V., Oschepkova E.V., Zelveyan P.A., Buniatyan M.S., Rogoza A.N.
Abstract
Aim. To estimate the time intervals of a morning arterial pressure urge (MAPU) and MAPU characteristics in patients with essential hypertension (EH). Material and methods. The study enrolled 70 patients (50 male and 20 female) with EH of the first (n = 41) and second (n = 20) degrees aged 34-65 years (mean age 50.4 ±0.9 years). The control group consisted of 9 healthy men. Morning dynamics of arterial pressure (AP) and heart rate (HR) was studied basing on the data of 24-h AP monitoring (Spacelabs-90207, USA). Results. Dynamics of AP from nocturnal to diurnal patterns in both hypertensive and normotensive subjects falls into 3 phases: a premorning urge (from 4-5 a.m. to waking up) with a characteristic slow rise in AP and HR; a morning urge (from waking up for 4-5 hours) with a characteristic forced AP and HR rise); a diurnal urge (from 11 a.m. to 13-14 p.m.) with characteristic slowing down of AP and HR rise. Patients with EH of the first and second degree vs normotensive subjects had unfavourable changes in morning dynamics of AP and HR: a significant progressive growth of maximal systolic and diastolic pressure proportional to mean circadian AP levels; a rise of morning hours index of AP which characterizes amplitude-speed features of AP and HR. Conclusion. To characterize MAPU most completely it is recommended to estimate the following parameters: wave index (to assess AP conversion from one level to another), mean rate of AP change per hour (to prevent influence of random factors on the rate of MAPU); relative maximal values of AP (to estimate maximal AP values in morning hours and nocturnal mean AP).
Terapevticheskii arkhiv. 2004;79(4):65-69
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Cytokines and cytokine therapy in gastrointestinal diseases
Tsaregorodtseva Т.М., Serova Т.I., Ilchenko L.Y., Sukhareva G.V., Sokolova G.N., Trubitsyna I.E., Nikolskaya K.A., Klishina M.V., Lazebnik L.B.
Abstract
Aim. To compare cytokine status in gastrointestinal diseases (GID) with reference to etiological factor, course, stage, therapy of the disease. Material and methods. Enzyme immunoassay was used to examine cytokines in the peripheral blood, tissue homogenates of 560 GID patients. GID were represented by ulcer disease (UD), cholelithiasis, chronic hepatitis (CH), glutenic enteropathy (GE), Crohn's disease (CD), nonspecific ulcer colitis (NUC). Results. In chronic recurrent GID (UD, cholelithiasis, GE) early exacerbation was characterized by elevated concentrations of IL-ip, IL-6, IL-8. Concentrations of IL-12, Infa,g, TNFa reached maximum on the height of the disease. Intensification of regenerative processes raised concentrations of IL4, IL-10. An overall level of serum cytokines averaged 190-780 pg/ml, reaching in some patients with active disease 1200-3000 pg/ml, in remission 30-110 pg/ml, in the control 40 pg/ml. In chronic progressive GID the levels of IL-10, IL-2, IL-8, IL-6 reached 30-80 pg/ml, IL-12, Infy, TNFa 150-370 pg/ml. A rise in cytokines concentrations in inflammatory viral, bacterial, autoimmune GID was higher than in cancer, alcoholism-related diseases, metabolic disturbances. Basic therapy in patients with chronic recurrent GID led to a significant fall in concentration of serum cytokines. Therapy with monoclonal antibodies to TNFa was associated with transitory pronounced favourable changes in peripheral blood cytokine status. Conclusion. GID provoke elevation of serum and tissue cytokines, impairment of cytokine balance in correlation with the etiological factor, variants of the course, stage of the disease, on-going therapy.
Terapevticheskii arkhiv. 2004;79(4):69-72
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Quality of life, clinical symptoms and nasa! passability in patients with allergic rhinitis
Emelyanov A.V., Trendeleva Т.Е.
Abstract
Aim. To examine correlations between quality of life, impairment of nasal passability and severity of clinical symptoms in patients with allergic rhinitis (AR). Material and methods. The examination of 54 AR patients (41 females, 13 males age 18-62 years, mean age 38 years) diagnosed seasonal AR in 19 and year-round AR in 35 patients. Quality of life was assessed by RQLQ questionnaire. Nasal inspiratory peakflowmetry was used to assess nasal obstruction. AR symptoms were registered by self-control score method. Results. Most parameters of quality of life of AR patients correlated significantly with severity of clinical symptoms, the degree of nasal passability. Positive changes in clinical symptoms, nasal peakflowmetry evidence correlated with improvement of life quality in the course of treatment with a present-day antihistamine drug fexofenadin (120 mg/day) for 28 days. Conclusion. Quality of life in AR patients correlated with severity of clinical symptoms and the degree of nasal obstruction. Assessment of life quality should be included in the scheme of standard examination of AR patients.
Terapevticheskii arkhiv. 2004;79(4):72-75
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Current problems of clinical diagnosis of infectious diseases
Bogomolov В.Р.
Abstract
Terapevticheskii arkhiv. 2004;79(4):75-78
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Current methods of immune and gene diagnosis in clinical practice
Suchkov S.V., Moskalets О.V., Cherepakhina N.E., Burdakova Y.A., Suntsova I.G., Shumsky V.I., Shaikhaev G.O., Elbeik Т., Beringer S., Petrauskene O.
Abstract
Terapevticheskii arkhiv. 2004;79(4):78-83
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Markers of renal function and assessment of progression of renal failure
Papayan A.V., Arkhipov V.V., Beresneva E.A.
Abstract
Terapevticheskii arkhiv. 2004;79(4):83-90
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Self-control of arterial pressure at home as a method of improving compliance in hypertensive patients
Oschepkova E.V., Tsagareishvili E.V., Zelveyan P.A., Rogoza A.N.
Abstract
Terapevticheskii arkhiv. 2004;79(4):90-94
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RAMS academician Valentin Ivanovich Pokrovsky - the 75th anniversary of birth
- -.
Abstract
Terapevticheskii arkhiv. 2004;79(4):94-96
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