Vol 87, No 11 (2015)


Chronic hepatitis C in Russia: current challenges and prospects

Chulanov V.P., Pimenov N.N., Mamonova N.A., Sagalova O.I., Shestakova I.V., Pokrovsky V.I.


This paper evaluates the impact of different medical care strategies for chronic hepatitis C patients in relation to its prevalence, frequency of adverse outcomes and mortality rate.
Terapevticheskii arkhiv. 2015;87(11):5-10
pages 5-10 views

Brucellosis in the Stavropol Territory: Results of 15-year follow-up of epidemiological and clinical features

Sannikova I.V., Makhinya O.V., Maleev V.V., Deineka D.A., Golub O.G., Kovalchuk I.V., Lyamkin G.I.


Aim. To analyze the epidemiological situation of brucellosis in the Stavropol Territory and to determine the specific features of its acute form. Materials and methods. The epidemiological situation of brucellosis in the Stavropol Region was retrospectively analyzed using the 2000-2014 official statistics of the Russian Federation and Stavropol Territory for brucellosis cases, individual documents of the Russian Federal Service for Supervision of Consumer Rights Protection and Human Welfare Directorate in the Stavropol Territory and Russian Federation, and medical records of the Brucellosis Department, Stavropol Hospital Two. Results. Brucellosis is a social problem in a group of focal zoonotic infections in the Russian Federation. In the North Caucasian Federal District, the largest number of new human brucellosis cases was notified in the Republic of Dagestan (59.3%) and Stavropol Territory (27.4%). The incidence of brucellosis in the Stavropol Territory was 5—10-fold higher than that in the Russian Federation as a whole. The true prevalence of brucellosis was 25% greater than the statistical data in terms of its clinical forms that were not included in official registration. Infection occurred in humans by contact with large and small cattle in 49.7% of cases. The disease mainly affected men (78.3%) and able-bodied people (67.7%); 78.5% of the patients seeking medical advice and as high as 79.9% of those being covered by serological examination of groups at risk for brucellosis were detected. There was a declining trend for the number of occupational brucellosis cases. At the same time, brucellosis accounted for 75% of the territory’s total number of occupational diseases. In the past decade, brucellosis has exhibited a relatively benign course (91.3% for its moderate form), by predominantly involving the osteoarticular system (63%). Non-compliance with outpatient antibacterial therapy is one of the factors for brucellosis chronization. 28.2% of the patients who had undergone a complete therapy cycle developed chronic brucellosis less frequently (p<0.005) than those who had stopped treatment for different reasons. Conclusion. Registration of brucellosis among humans is a result of the unfavorable epizootic situation of animal brucellosis. The highest incidence of brucellosis is observed in the northeastern areas of the Stavropol Territory, which border the Republic of Dagestan. The true prevalence of brucellosis greatly exceeds the official statistical data. Active detection of infection and timely diagnosis will be able to determine the real epidemic situation of brucellosis. Continuity of management and follow-up will provide a reduction in medical and social losses associated with this infection.
Terapevticheskii arkhiv. 2015;87(11):11-17
pages 11-17 views

Relapsing (recurrent) disease caused by Borrelia miyamotoi

Sarksyan D.S., Maleev V.V., Platonov A.E., Platonova O.V., Karan L.S.


Aim. To clarify the clinical, laboratory, and epidemiological characteristics of relapsing Ixodes tick-borne borreliosis (ITB) caused by Borrelia miyamotoi. Subjects and methods. Retrospective clinical observation was made in 79 inpatients of the Republican Infectious Diseases Hospital (Udmurt Republic), who had been diagnosed with B. miyamotoi-caused disease verified by real-time polymerase chain reaction. The latter and enzyme immunoassay ruled out possible vector-borne coinfections (ITB caused by B. burgdorferi sensu lato; tick-borne encephalitis; anaplasmosis; and ehrlichiosis). Results. The recurrent course of the disease was observed in 8 (10%) of the 79 patients. The relapsing fever curve was noted in 6 of the 8 patients; 4 patients had 2 episodes of fever and 2 patients had 3 episodes; the wave-like continuous type of fever cannot enable one to estimate the specific number of episodes in 2 more cases. Relapses occurred in all the 8 patients before antibiotic treatment. Febrile syndrome (weakness, headache, chill, fever, sweating, dizziness, nausea, vomiting, myalgia, and arthralgia) was leading in patients with relapses. These patients were less frequently observed to have signs of organ dysfunctions than those with one episode of fever. The values of clinical and biochemical blood tests and urinalyses were normal and near-normal in the majority of patients on hospital admission. Conclusion. Relapsing B. miyamotoi infection cases detected in the directed study proved to be unrecognized by practical health authorities during the first and sometimes second episodes of fever. This indicates that the prevalence of this disease is essentially underestimated and there is a need to increase physicians’ alertness and awareness and to introduce adequate diagnostic methods.
Terapevticheskii arkhiv. 2015;87(11):18-25
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The blood coagulation system and microcirculatory disorders in ixodid tick-borne borreliosis caused by Borrelia miyamotoi

Platonov A.E., Sarksyan D.S., Karan L.S., Shipulin G.A., Gordygina E.V., Malinin O.V., Maleev V.V.


Aim. To study blood coagulation and microcirculatory disorders as a possible cause of transient dysfunctions of organs (the kidney, liver, heart, lung, etc.) in patients with ixodid tick-borne borreliosis caused by Borrelia miyamotoi (Bmt). Subjects and methods. Twenty-four patients with Lyme disease (LD) and 28 Bmt patients treated at Izhevsk City Hospital (Udmurtia) were examined in the study. Platelet counts and the presence of D-dimers were determined; activated partial thromboplastin time, prothrombin time, thrombin time, fibrinogen and antithrombin III levels, and Factor XIIa-dependent fibrin clot lysis time were measured. Slit lamp microscopy of the conjunctiva was also carried out. Results. Platelet counts were less than 150,000 per μL of blood in 43% of the Bmt patients. All the Bmt patients had at least one abnormal coagulation parameter of the eight ones that were tested; 64% of them had marked coagulation disorders with three or more abnormal laboratory findings. In contrast, all the eight parameters were normal in 71% of the LD patients. The other seven LD patients had only one or two abnormal coagulation parameters (p<0.001 in comparison with Bmt patients). Microscopic examination of eye capillary blood flow revealed pathological findings that included aggregates of erythrocytes and obstructed and/or sinuous capillaries in 22 (79%) of the Bmt patients, but none of the LD patients. A total of 14 Bmt patients had both coagulation and microcirculatory abnormalities. Eleven of them also had transient signs of organ dysfunction. Conclusion. As far as Borrelia secrete no known toxins, we hypothesized that uncovered disorders of blood coagulation and microcirculation in Bmt patients may contribute to organ dysfunction.
Terapevticheskii arkhiv. 2015;87(11):26-32
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HIV infection risk perception and stigmatizing attitude: Results of surveys of dwellers from the Central Administrative District of Moscow

Belyaeva V.V., Adigamov M.M., Sokolova E.V., Orlova M.О.


Aim. To study human immunodeficiency virus (HIV) infection risk perception and stigmatizing attitudes in the dwellers of the Central Administrative District of Moscow. Subjects and methods. An anonymous survey was conducted using specially developed questionnaires. A total of 893 people were interviewed. Each of the given indicators was used to ask 98 to 254 respondents. Among the survey participants, there were 92 healthcare workers, including 66 physicians and 26 representatives of middle-level and junior medical staff. According to their replies, the respondents were divided into 2 groups: 1) healthcare workers; 2) representatives of the so-called general population. Results. 91.3% of the healthcare workers gave a negative reply to the question: «Should contacts (intercourse) with people living with HIV (AIDS) be avoided to escape infection?». In Group 2, 58.8 and 23.5% of the respondents answered negatively and positively, respectively; and 17.6% had difficulty answering the question. In the general population group, 44.1% of the respondents answered negatively and 32.2% had difficulty answering the question: «Would you agree to live in the same room with anybody whom you know or suspect to be HIV positive?»; 23.8% agreed to do this. Among the healthcare workers, there were 46.7% of the respondents who answered positively. When the question: «Would you agree to send your child (grandson) to the kindergarten if you would learn that a HIV-infected child goes there?» was asked, 48.6 and 18.7% of the respondents in the general population group answered negatively and positively, respectively; 32.7% had difficulty answering. In the group of healthcare workers, 66.7% answered positively. Among both the healthcare workers and the representatives of the general population, more than 60% of the respondents agreed with the statement that «HIV-infected people lead a loose life». Conclusion. The specific features of perceiving a HIV infection risk and showing stigmatizing attitudes towards HIV-infected patients make the forming less dangerous behaviors difficult and restrict an access to care and support in infected patients. The training of healthcare workers in issues related to HIV infection should involve the identification of stigmatizing attitudes and the application of destigmatization strategies.
Terapevticheskii arkhiv. 2015;87(11):33-36
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Impact of etiotropic therapy on the immune status of patients with HIV infection and tuberculosis

Zimina V.N., Kravchenko A.V.


Aim. To evaluate the impact of etiotropic therapy on the immunological efficiency of treatment in patients with HIV infection in relation to the presence of active tuberculosis (TB) and the baseline count of CD4+ lymphocytes. Subjects and methods. A total of 239 HIV-infected patients were examined and divided into 3 groups: 1) 103 HIV-infected patients with TB who received both anti-TB therapy (ATBT) and antiretroviral therapy (ART); 2) 46 HIV-infected patients with TB who did not receive ART during TB treatment; 3) 90 HIV-infected patients without TB who used ART for the first time. CD4+ lymphocyte counts were measured by flow cytofluorometry in all the patients before and 4 and 12 weeks after treatment. Results. Analysis of an increment in CD4+ lymphocyte counts in the HIV-infected patients with tuberculosis showed that those who had very low baseline CD4+ lymphocyte counts (median, 78 cells/µl) were noted to have significant positive changes (median, +146 cells/ µl) at 12 weeks of ART. Even without ART, effective ATBT in the patients with a well preserved immune system (>350 CD4+ cells/µl) in turn resulted in a substantial increase in CD4+ lymphocyte counts (median, +187 cells/µl following 12-week ATBT). At the same time, 10.9% of the patients showed a decrease in the baseline CD4+ lymphocyte counts during progression or delay in the tuberculosis process, which required that ART should be promptly performed. Conclusion. The investigation of the time course of changes in the increment of CD4+ lymphocyte counts revealed a swifter response to ART as their rapid increment in patients with coinfection (HIV infection concurrent with TB) than that in those with HIV monoinfection. When the baseline CD4+ lymphocyte counts are over 350 cells/µl, the start of ART should be delayed until TB treatment is completed.
Terapevticheskii arkhiv. 2015;87(11):37-41
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Follow-up study of HIV-infected patients with prior cerebral toxoplasmosis

Ermak T.N., Peregudova A.B.


Aim. To assess follow-up study results in human immunodeficiency virus (HIV)-infected patients with prior cerebral toxoplasmosis (CT). Subject and methods. Follow-up study results were assessed in HIV-infected patients with prior CT. Results. The fate of only 97 out of 137 (66% of the hospitalized) patients discharged from hospital is known, as 40 convalescents have been lost to follow up. Thereafter, relapses developed in 19 patients, of whom 6 died. Eleven more patients with HIV infection died due to its progression and development of other secondary lesions. Five more patients died from narcotic overdose, staphylococcal sepsis, and acute pancreatic necrosis. The main peak of fatal outcomes was within the first 2 years after discharge. 3.5-year survival rates after TC were 75%. The causes of recurrent and progressive HIV infection were non-compliance with secondary prevention of CT and low adherence to an antiretroviral therapy regimen, the blame of which fell not only on the patients, but also their attending physicians and specialists who had advised how to enhance treatment motivation. Conclusion. Further follow-up of convalescent CT patients calls for closer attention to the possible development of recurrences within the first three years after discharge in particular, regardless of CD4 cell counts.
Terapevticheskii arkhiv. 2015;87(11):42-45
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Assessment of factors influencing the outcome of new-onset infiltrative pulmonary tuberculosis

Mordyk A.V., Puzyreva L.V., Batishcheva T.L.


Aim. To identify predictors for the poor outcome of infiltrative pulmonary tuberculosis (IPTB). Subjects and methods. The social, epidemiological, and medical risk factors and clinical features of IPTB were assessed in 130 first detected patients. The findings were classified using a cluster analysis and then a variance analysis, followed by the ranking of its results. Results. The primarily diagnosed disseminated destructive process with respiratory and cardiopulmonary failure, excretion of both resistant and multi-resistant pathogenic bacteria had a strong impact on the poor outcome of tuberculosis (TB) in the first detected patients. Its outcome was also influenced by a set of social factors, such as poor material living conditions, stay in corrective labor facilities, and a lack of education. The unfavorable outcome of TB was significantly due to organizational factors, such as bad habits; refusal to undergo fluorography during a few years; and a medical factor as comorbidities. Conclusion. Based on the identified factors, the authors formulated recommendations for working with the first detected IPTB patients at risk for a poor disease outcome.
Terapevticheskii arkhiv. 2015;87(11):46-50
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Combination drugs in the therapy of acute respiratory viral infections: Evaluation of clinical and economic effectiveness

Zaitsev A.A., Klochkov O.I.


Aim. To make a comparative clinical and economic evaluation of the use of the combination drug Influnet in the treatment of acute respiratory viral infections (ARVI). Subjects and methods. A total of 103 medical records of outpatients with uncomplicated mild and moderate ARVI were studied. There were three groups: 1) 35 patients who received therapy with Influnet; 2) 31 patients who took Rinza; 3) 34 patients who were on treatment without the combination drug. Results. Analysis of comparative clinical effectiveness of the drugs revealed that the use of Influnet was accompanied by the rapider alleviation of fever and other ARVI symptoms and by its shorter treatment duration (4.5±0.5 days) versus that of Rinza (5.5±1.4 days) and monocomponent drugs (5.6±1.2 days). Economic analysis showed that in terms of indirect costs associated with shorter temporary disability in patients with ARVI, Influnet therapy was more economically sound for them. Conclusion. The results demonstrate the higher clinical and economic feasibility of Influnet therapy for ARVI versus its alternative therapy. Combination drugs cause fewer adverse reactions than a combination of monocomponent drugs used to treat ARVI and are more cost- effective for the patient.
Terapevticheskii arkhiv. 2015;87(11):51-55
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Inflammatory diseases of scrotal organs in patients with brucellosis: Improvement of therapy

Lyapina E.P., Shuldyakov A.A., Evdokimov A.V., Glybochko P.V.


Aim. To evaluate the efficacy of cycloferon used in the combination treatment of scrotal inflammatory diseases (SID) in patients with brucellosis. Subjects and methods. A total of 150 male patients with chronic brucellosis (CB) were examined. Inquiry, questioning, physical and ultrasound examinations, and spermiogram analysis were used to detect of diseases of the reproductive system. Twenty-two CB patients with SID were examined over time (before and after cycle therapy). In Group 1, combination therapy included 2 cycles of five intramuscular injections of cycloferon 0.25 g in each at a 10-day interval. In Group 2, a package of therapeutic measures meets the generally accepted standards. И Incorporation of cycloferon into the combination therapy of SID patients with CB positively affected the time course of clinical changes and spermatogenesis, declines the number of SID exacerbations, improved quality of life, and failed to cause side effects. Conclusion. The findings allow us to recommend cycloferon as the drug of choice in treating CB patients with SID.
Terapevticheskii arkhiv. 2015;87(11):56-61
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Survival in pulmonary arterial hypertension, associated with connective tissue diseases, treated by sildenafil: results of the prospective study

Volkov A.V., Nikolaeva E.V., Yudkina N.N., Kurmukov I.A., Nasonov E.L.


Aim. To investigate the effect of sildenafil on the survival of patients with pulmonary arterial hypertension (PAH) associated with connective tissue diseases (CTD), who have been followed up at the Rheumatology Expert Center. Subjects and methods. A total of 16 patients (all women) with PAH associated with CTD, who had been admitted to the V.A.Nasonova Research Institute of Rheumatology in 2013—2015, were examined. PAH corresponded to Functional Class II in the majority of the patients. After the diagnosis was verified by catheterization of the right heart and pulmonary artery, all the patients reсeived original sildenafil (a phosphodiesterase type 5 inhibitor, a potent vasodilator, the efficiency of which was proven in patients with PAH) at a dose of 20 mg thrice daily. Survival rates and time to clinical deterioration were estimated during a prospective follow-up). Results. Three-year survival rates were 94% in the study group and 25% in the group of historical control (p<0.05). The time to clinical deterioration was associated with the duration of the follow-up and hemodynamic parameters (right atrial pressure and changes in vascular resistance within 4 months after therapy initiation). Conclusion. The administration of sildenafil substantially improves survival in patients with PAH associated with CTD as compared with the historical control. The identification of poor prognostic factors in this cohort of patients and early diagnosis will favor the personification of therapy for the fatal manifestation of CTD.
Terapevticheskii arkhiv. 2015;87(11):62-67
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Genes of killer cell immunoglobulin-like receptors and their HLA ligands after allogeneic hematopoietic stem cell transplantation in myeloid leukemia patients

Khamaganova E.G., Parovichnikova E.N., Kuzmina L.A., Kulikov S.M., Savchenko V.G.


Aim. To study the impact of the genes of donor killer cell immunoglobulin-like receptors (KIR) and HLA—KIR ligands on overall (OS) and event-free survival (EFS) rates in patients with myeloid leukemia after transplantation with allogeneic hematopoietic stem cells (allo-HSCT) from HLA-identical related and HLA-compatible unrelated donors. Subjects and methods. The investigation enrolled 29 patients who had undergone allo-HSCT from KIR-genotyped donors at the Department of Bone Marrow Transplantation, Hematology Research Centerб in 2010-2013. OS and EFS rates after allo-HSCT were calculated using the Kaplan-Meier method. Results. The main predictor of recurrence and survival in patients after allo-HSCT was a recurrence-risk group the patient belonged to before transplantation. The standard-risk group patients whose donors had telomeric gene-content motifs of KIR-B haplotypes had higher EFS rates than those whose donors lacked these genes. The standard-risk patients homozygous for HLA-1 alleles (i.e. without HLA-C2 ligand) tended to have higher EFS rates, so did the patients without HLA-Bw4 ligand. Conclusion. The donors having telomeric gene-content motifs of KIR-B haplotypes are more preferred for allo-HSCT for patients with myeloid leukemia as the presence of donor telomeric KIR-B genes increases EFS rates in standard-risk patients.
Terapevticheskii arkhiv. 2015;87(11):68-77
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Nodular lymphocyte-predominant Hodgkin’s lymphoma: Principles of diagnosis and treatment

Moiseeva T.N., Al-radi L.S., Kovrigina A.M., Goryacheva S.R., Julakyan U.L., Margolin O.V., Skidan N.I., Tseytlina M.A., Kravchenko S.K.


Aim. To describe the clinical and morphological features of the rare Hodgkin’s lymphoma (HL) subtype — nodular lymphocyte-predominant HL (NLPHL). Subjects and methods. Forty-two patients were diagnosed with NLPHL in 2010 to 2014. The male to female ratio was 2.2:1; the median age was 37 years (range 17—68 years). NLPHL was diagnosed on the basis of the histological and immunohistochemical examinations of tumor biopsy specimens; disease stages were determined by standard HL studies. Results. Before NLPHL was detected, 23 (55%) patients were diagnosed as having HL in 13 cases, follicular lymphoma in 2, lymphofollicular hyperplasia in 3, angioimmunoblastic lymphoma in 1, diffuse large B-cell lymphoma in 3, and B-cell lymphoma (non-HL) in 1. Long-term (3—21-year; median 8 years) persistent lymphadenopathy was observed in 16 (38%) patients. Seventeen (40.5%) patients had early (I—II) stages of the disease and 25 (59.5%) had advanced stages. B symptoms were noted in 24% of cases. There was involvement of extranodal sites (salivary gland, tonsil) in 2 patients, spleen in 14 (33%), bone marrow in 8, and bulky disease in 2. Cycles of ABVD ± rituximab ± radiotherapy (RT) were used in early-stage NLPHL; those of R-ВЕАСОРР-14 ± RT were performed in the advanced stages of the disease or its transformation to diffuse large B-cell lymphoma with excessive T cells. Conclusion. When patients have a history of long-term asymptomatic lymphadenopathy, it is necessary to rule out NLPHL, for which purpose an immunohistochemical examination of a biopsy specimen and its reexamination in a laboratory having experience in diagnosing NLPHL must necessarily be done. Lower RT doses and rituximab incorporated into the cycle of treatment are indicated to reduce its toxicity and to preserve therapeutic efficiency.
Terapevticheskii arkhiv. 2015;87(11):78-83
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Description of a case of severe Q fever

Malov V.A., Ponomarev S.V., Тarasevich I.V., Kubensky E.N., Gorobchenko A.N., Pantyukhina A.N., Nemilostiva E.A., Bogdanova M.V., Makhmutov Y.I.


The paper considers a rare clinical case of severe Q fever in a young man with no compromised premorbid background. It describes and analyzes clinical manifestations and laboratory findings with consideration for the current data available in the literature. The issues of the differential diagnosis, laboratory diagnosis, and treatment of Q fever are discussed.
Terapevticheskii arkhiv. 2015;87(11):84-91
pages 84-91 views

A case of adenovirus infection complicated by gram-negative polymicrobial sepsis: A clinical and morphological observation

Esipov A.V., Shklovsky B.L., Patsenko M.B., Apevalov S.I., Chirsky V.S., Ovchinnikov Y.V., Tatarin V.S., Fokin Y.N., Peredernin S.F., Bobrov A.N., Yatsyshina S.B., Dolgikh R.N., Lishchuk A.N., Koltunov A.N., Kornienko A.N., Khlobystov V.A., Prokhorchik A.A., Ageeva M.R., Maleev V.V., Baksheev V.I.


Among respiratory infections, adenovirus infection (ADVI), in the presence of which there may be severe pneumonia that frequently results in a fatal outcome, occupies particular attention. ADVI in patients without immunodeficiency is usually mild and shows a limited extent of injury. At the same time the disease in immunocompromised individuals may be severe, presenting with viremia, evolving sepsis, and high death rates. The paper gives a characteristic example of severe ADVI and its fatal outcome.
Terapevticheskii arkhiv. 2015;87(11):92-96
pages 92-96 views

Secondary diseases and Burkitt’s lymphoma in HIV-infected patients

Mikhailova N.R., Ermak T.E., Anikeev A.A.


The authors give the clinical data of 110 human immunodeficiency virus (HIV)-infected patients who stayed in a correctional facility during 2014. Of the examinees, there were almost 50% of the patients with advanced stages (IVA—IVB) with different secondary/opportunistic diseases, among which was Burkitt’s lymphoma, a rather rare malignant disease that developed in obvious immunodeficiency in the absence of antiretroviral therapy.
Terapevticheskii arkhiv. 2015;87(11):97-98
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Successful treatment for cryptococcal meningoencephalitis complicated by cerebral salt-wasting syndrome in a patient with chronic lymphocytic leukemia: A clinical case

Potapenko V.G., Konovalenko I.B., Oksema Е.V., Filippova L.N., Dulaeva E.N., Derevyannykh N.А., Krasnoruzhsky А.I., Klimovich A.V., Klimko N.N., Medvedeva N.V.


Cryptococcus neoformans is a common agent of fungal meningoencephalitis in immunocompromised patients. Cerebral salt-wasting syndrome is one of the rare causes of severe hyponatremia in patients with CNS diseases. The paper describes the first clinical case of a patient, whose onset of chronic lymphocytic leukemia was complicated by cryptococcal meningoencephalitis presenting with mental disorders and severe electrolytic imbalance. Antifungal treatment with amphotericin B and fluconazole could alleviate an infectious process and metabolic disturbances.
Terapevticheskii arkhiv. 2015;87(11):99-102
pages 99-102 views

Microbial dormancy and prevention of healthcare-associated infections

Tutelyan A.V., Gaponov A.M., Pisarev V.M., El-registan G.I.


Healthcare-associated infections (HCAI) remain one of the most challenges of modern health care and assume increasing social and medical significance. The specific features of HCAI are frequent recurrences and inefficiency of antibiotic therapy, a reason for which is antibiotic resistance in microorganisms. The review discusses antibiotic resistance, a form of antibiotic tolerance (AT), and its role in the development of HCAI. It also describes essential differences between AT and antibiotic tolerance at the cellular and molecular genetic levels. Relationships between AT and dormancy of microorganisms, pathogens of HCAI, are discussed. The paper gives the data available in the literature on how AT occurs in HCAI pathogens and discusses the diagnosis of this condition. It also analyzes the literature data on pharmacological attempts to overcome AT and discusses novel approaches to antibiotic therapy for HCAI.
Terapevticheskii arkhiv. 2015;87(11):103-108
pages 103-108 views

Spread of nosocomial infection in obstetric hospitals

Adamyan L.V., Kuzmin V.N., Arslanyan K.N., Kharchenko E.I.


The paper highlights the topical problems of nosocomial infection in the practice of obstetrics and perinatology. It systematizes procedures for controlling the occurrence of nosocomial infection and preventing its spread, such as identification of risk groups and risk factors and prerequisites for complications of epidemiological surveillance, as well as specific diagnosis in pregnant women. Group B streptococcus, one of the major pathogens of nosocomial infection, is described.
Terapevticheskii arkhiv. 2015;87(11):109-112
pages 109-112 views

Topical problems of antiviral therapy for chronic hepatitis C

Bakulin I.G.


Antiviral therapy using interferon-free regimens for chronic hepatitis C (CHC) is being more frequently practiced by hepatologists due to the high efficiency of a short treatment cycle and the lowest rate of adverse events. The review discusses the most topical problems that will present themselves in practicing hematologists when treating patients with CHC under the present-day conditions. The use of direct-acting antiviral drugs requires knowledge and skills for physicians to orient themselves in the list of these drugs to create their based regimens, the efficiency and safety of which are proven in the context of evidence-based medicine. The review gives data on the efficiency and safety of 3D therapy for CHC according to the baseline characteristics of patients.
Terapevticheskii arkhiv. 2015;87(11):113-117
pages 113-117 views

Approaches to antiretroviral therapy in HIV-infected patients with low CD4 lymphocyte counts

Shakhgildyan V.I., Yagodkin M.V.


There are increasing numbers of patients with late-stage HIV infection in the Russian Federation. To choose optimal antiretroviral therapy regimens for patients with severe immunosuppression is a relevant problem. According the data obtained in the ECHO and THRIVE, ARTEMIS, CASTLE, SPRING-2 and other trials, the efficacy and/or safety of efavirenz are higher than those of rilpivirine, comparable with those of raltegravir and dolutegravir; darunavir and atazanavir are more effective than lopinavir, but dolutegravir is more effective than raltegravir (in numerical terms) in patients with low CD4 lymphocyte counts (less than 50 cells/µl or 200 cells/µl depending on a trial. To choose therapy for patients with late-stage HIV infection is an intricate problem and requires an individual approach that will take into account not only the efficiency of therapy, but also its possible side effects, as well as potential drug interactions for the treatment of opportunistic infections.
Terapevticheskii arkhiv. 2015;87(11):118-122
pages 118-122 views

The etiopathogenetic bases for antibacterial therapy and prevention of urinary tract infections

Kayukov I.G.


The paper discusses the pathogenesis of urinary tract infections, the mechanisms of resistance in their pathogens to antimicrobials and uroseptics, and approaches to defining patient management tactics.
Terapevticheskii arkhiv. 2015;87(11):123-133
pages 123-133 views

Blood component donors and recipients as linked study objects in epidemiological population-based surveys

Garmaeva T.T., Kulikov S.M.


A population of hematological cancer patients as recipients of many blood components and that of donors of blood components and bone marrow are related to the common event of contamination with viruses of blood-borne infections, which occurs and is detectable during long-term treatment and follow-up. They share interaction traits and diverse communication mechanisms, which call for complex interrelated trials in both groups with a mandatory epidemiological evidenced-based investigation of all cases of posttransfusion hepatitis B and/or C. The identity of infection with hepatitis B and C viruses, human immunodeficiency virus, and their association should be simultaneously studied in the populations of both donors and recipients of blood components and bone marrow.
Terapevticheskii arkhiv. 2015;87(11):134-138
pages 134-138 views

Enteric microbiocenotic modifiers and ways of enhancing their efficacy

Lipova E.V., Yakovlev A.B., Aivazian A.A.


Efficient recovery of enteric microbiocenosis is one of the central problems not only in gastroenterology, but also in a number of related areas. This problem becomes particularly pressing after antibiotic treatment. The combined modifiers of enteric microbiocenosis are most effective among other symbiotic drugs. Bion-3 apart from symbionts contains a vitamin/mineral complex and acts as an adaptogen.
Terapevticheskii arkhiv. 2015;87(11):139-143
pages 139-143 views

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