The objective: To investigate etiological structure of adenoviral diseases in young people from organized groups and the clinical features of acute respiratory disease caused by different serotypes of adenovirus were identified.

Materials and methods: A total 382 patients with adenovirus
infections were investigated. Virus isolation from nasopharyngeal swabs was carried out in cell cultures Vero, HeLa, Hep-2. Typing of adenoviruses was performed by virus neutralization test with polyclonal rabbit subtype specific sera. The average (M), standard deviation (SD) and frequency of occurrence (%) of clinical signs (respiratory and non-respiratory syndromes of pneumonia, protracted and recurrent course was calculated. Significance of the differences (p<0,05) of average frequency of cases compared to independent group of patients was evaluated by Student t-test and criterion φ2 (phi – square) Fischer, respectively.

Results: As result of investigation 199 adenovirus strains (52,1 %) were isolated. 183 strains were serotyped: 64 (32,2 %) – 3 serotype, 42 (21,1 %) – 4 serotype, 38 (19,1 %) – 7 serotype, 15 (7,5 %) – 5 serotype, 11 (5,5 %) – 21 serotype, 8 (4,0 %) – 1 serotype, 3 (1,5 %) – 2 serotype, 2 (1,0 %) – 6 serotype. In assessing the features of the clinical course of adenoviral infection caused by the most actual serotypes (3, 4, 7) of adenovirus revealed that duration of diseases caused by serotype 7 was significantly longer and remained febrile fever (4,3±2,74 days, p<0,05), rhinitis (9,4±6,01 days, p<0,05), pharyngitis (7,9±2,87 days, p<0,05), laryngitis (7,3±2,87 days, p<0,05) and bronchitis (11,8±8,03 days, p<0,05), tonsillitis (63,0%, φ2=12,6, p<0,05), lymphadenopathy (63,0%, φ2=4,1, p<0,05), and pneumonia (34,2%, φ2=3,84, p<0,05) were registered significantly more frequently.

Conclusion: The study showed that the adenoviruses of 3, 4 and 7 serotype have the greatest epidemiological significance. Clinical features of adenoviral diseases caused by 7 serotype were manifested in more frequent registration of non-respiratory syndromes and the development of pneumonia.

Objective: to study the clinical and epidemiological characteristics, the nature of the course and outcomes of the disease in children with rotavirus mono- and mixed viral - bacterial lesions of the gastrointestinal tract.

Materials and methods: in this work the results of clinical observations of 143 patients with rotavirus infection before the age of 1 year. At the same time 69 children were diagnosed with rotavirus gastroenteritis, while 74 people. there has been a combination of rotavirus with the pathogenic microflora.

Results and conclusion: The clinical picture of combined forms of rotavirus infection differed for signs of defeat all parts of the gastrointestinal tract, inflammatory changes in the blood and coprogram. Combined damage to the intestinal mucosa and the associated inflammation conditioned a «non-smooth» during the acute period of the disease, which significantly increased the duration of treatment and hospital stay.

As a result of wide and irrational antibiotics using the problem of AAC has become an issue. According to medical sources Clostridium difficile-associated diarrhea (pseudomembranous colitis) is not registered and its clinical diagnostics is unsatisfactory.

The purpose of the research is to study the pseudomembranous
colitis incidence on autopsy material in a multi-type hospital and to give its clinical and morphological characteristics.

Methods and materials: the medical records (autopsy protocols, patients’ histories) of the deceased with pseudomembranous colitis diagnosed on autopsy for the period of 2008–2013 yy were analyzed. The macroscopic changes of small and large bowel (size and pseudomembrane location, lesion focus, other colonic wall variations) were assessed on autopsy. The stainings by hematoxylin-eozin, azur, PAS-reaction were used for histological diagnostics. The bacteriological testing was conducted in 2 cases.

The results. The growing tendency of the pseudomembranous colitis frequency as well as its parts in the autopsy structures were revealed. Six cases of pseudomembranous colitis are detected on autopsy (0,28% of all performed autopsies in Irkutsk hospital №1) for 2008–2010 y.y. Twenty cases of pseudomembranous colitis were registered for 2011–2013 y.y., that was 1,52% in the autopsy structure. The risk factors of pseudomembranous colitis development, its clinical and morphological presentations were identified. Low lifetime diagnostics of this disease was remarked and its causes were analyzed.

Conclusion. The problem of antibiotic-associated diarrhea with pseudomembranous colitis development is an issue because of the growing incidence of this disease and its unsatisfactory clinical diagnostics.

This article is dedicated to the connection between laryngeal
inflammatory pathology and influenza/common cold.

The purpose is to study the frequency of different form of laryngitis in children with common cold/ influenza, influenced of carried laryngitis within common cold on laryngeal structures and also the effectiveness of preventive measures against acute respiratory infections.

Material and methods are the results of the examination (including laryngeal endoscopy) and analysis of medical files of 3169 patients and also the data of the annual report of one Moscow semi-clinic.

Results. Inflammation laryngeal pathology was revealed in 152 (4,79%) cases, in 129 (84,9%) – non-obstructive. 91 patient (59,8%) belonged to category “frequently and often sick”. The recurrent episodes were seen in patients with both forms of laryngitis. Different laryngeal pathology (laryngitis, vocal nodules) was seen after common cold treatment with 43,5% obstructive and 18,63% non-obstructive laryngitis patient as well as dysphonia in 3-14% getting worse with the following common cold episodes. The preventative measures carried among patients with laryngitis allowed to decrease spreading of this pathology notwithstanding the fact of annual growth of common cold in children.

Conclusion. Thus taking to account the high circulation of respiratory viruses the absence of specific preventative measures and the especial role of viruses in development all forms of laryngitis it is recommended to include special drugs in preventative techniques of laryngitis prophylactics. Different methods of non-specific prophylactic are effective in decreasing the amount of common cold episodes, decrease the frequency and severity all forms of laryngitis in children and also tend to stabilize/normalize the voice quality in different laryngeal pathology children.

The purpose of the study – the optimization of clinical diagnosis of chronic course of Ixodes tick-borne borreliosis based on indicators of immune and cytokine status of patients.

Materials and Methods: clinical and immunological study of patients with chronic Ixodes tick-borne borreliosis in the Krasnoyarsk region. The observations were made on 205 patients for 1,5 years. The diagnosis was based on clinical and epidemiological data confirmed the identification of specific antibodies to borrelia by ELISA. The indices of cellular and humoral immune system, phagocytosis, cytokine (interleukin-1β, 4, 8 , tumor necrosis factor-α).

Results: Show Part chronicity of infection after an noneritemic form of the disease (37,5%) and combined forms of Ixodes tick-borne borreliosis with tick-borne encephalitis (33,2%). Clinical manifestations were characterized by the involvement in the pathological process of the musculoskeletal system (42,9%) and combined lesions to the nervous system (38.5%). A rare variant of the chronic course of borreliosis was central nervous system as the onset of the disease (3,5%). Common infectious syndrome relapse accompanied by autonomic dysfunction with prevalence parasimpatotonus (59,0%) and simpatotonus (41,0%), and febrile reactions (71,2%) were more subfebrile with fever (51,2%).

Conclusion: pathogenetic mechanisms of chronic course of Ixodes tick-borne borreliosis closely associated with inflammation and immune-mediated reactions of the organism , and are characterized by the presence of cellular immunodeficiency, insolvency phagocytosis, suppression of the synthesis of interleukin-4 and interleukin-8 intensive products.

The problem of pneumococcal infection is actual for many countries of the world in connection with high incidence and mortality. Vaccination by the 7-valent conjugated pneumococcal vaccine of children till 2 years is available in Russia since 2009, 13-valent – since 2012. Objectives – an assessment of clinical and epidemiological efficacy in pneumococcal infection prevention infection by catamnesis after 7-valent conjugated pneumococcal vaccine application. Observation over incidence of pneumonia and otitis of 50 children imparted against a pneumococcal infection is made. The indicator of density of incidence of pneumonia in group of the imparted made 9,7 on 1000 (95% of CI; 9,1–10,3) in group of comparison – 92,6 on 1000 (95% of CI; 91,3–93,9). Index of efficacy of vaccination concerning pneumonia of any etiology – 9,5, effectiveness ratio – 89,5%. The indicator of density of incidence of otitis at the imparted was 1,8 times less – 155,3 on 1000 (95% of CI; 150,9–155,7) in group of comparison – 263,9 on 1000 (95% of CI; 261,7–266,1). The index and vaccination effectiveness ratio concerning acute otitis media made 1,8 and 44,3%. Thus, vaccination against pneumococcal infection is effective as concerning community acquired pneumonia, and acute otitis media of any etiology.

Aim: To determine the value of gene polymorphisms of interleukin-28B (IL28B), RNase L, HLA DRB1*1101 and HLADQB1*03 alleles as predictors of antiviral treatment efficacy in patients with chronic hepatitis C (CHC).

Material and methods. A total of 156 in-patients with chronic hepatitis C (65.4% men, 62.4% had genotype 1 hepatitis C virus – HCV) were studied. The results of treatment with interferon (IFN) and ribavirin (RBV) were analyzed in 74 patients. Polymerase chain reaction identified single nucleotide polymorphisms (SNP) of the gene IL28B 39743165T>G (rs8099917), SNP 39738787C> T (rs12979860), RNase L gene (1385G>A), HLA DRB1*1101 and HLA-DQB1*03 alleles.

Results. In patients with HCV genotype 1 mutant alleles were more common in SNP 39743165T>G (p=0.001) and 39738787C>T (p=0.0002) than in patients with other genotypes. Response to therapy IFN/RBV was higher in those with “favorable” TT variant (SNP 39743165T>G) and CC (SNP 39738787C>T), in those with their combination virologic response ffect were found according to genes IL28B and RNase L SNP variants, DRB1*1101 and HLA-DQB1*03 alleles.

Conclusion. Testing for SNP 39738787C>T of IL28B gene is recommended before starting therapy IFN / RBV for all patients with genotype 1 HCV as a predictor of treatment response. Testing SNP 1385G>A gene RNase L and DRB1*1101, HLA-DQB1*03 alleles has no apparent prognostic value for patients with CHC antiviral therapy.

One of the phases of the natural course of chronic hepatitis В is «HBsAg negative» phase, the clinical and prognostic significance of which is not defined yet. The frequency of HBsAg negative phase of chronic hepatitis В among the hospitalized patients of Clinical Infectious Diseases Hospital named by S.P. Botkin (Saint-Petersburg), for the period of 2010–2012 was assessed in this study. We analyzed the age structure of the patients, their clinical-laboratory inde[es and set the frequency of cirrhotic stage of disease. The «HBsAg negative» phase is revealed among quarter of patients with chronic hepatitis В the middle aged group (45–59 years old). The 84 (67,2%) hospitalized patients with HBsAg negative chronic hepatitis В diagnosed were given a diagnosis of cirrhotic stage disease. Thus, the spontaneous clearance of HBsAg from blood serum is not always the evidence of the prognostically favorable course of chronic hepatitis B.

Aim: assessment of efficienty of Nooclerin in children with aseptic meningitis.

Materials and methods: our study was performed on 50 children with aseptic meningitis; efficiency of Nooclerin was analized. First group (main, 35 patients) took standart therapy and Nooclerin from the 5th day of hospitalization within 2 months; s cond group (control, 15 patients) took only standart treatment. During the whole period of hospitalization and 2 months after all patients were monitored with clinilalneurological signs. Assessment of asthenia was performed on the «Children asthenia’s symptoms scale» and «Schatz asthenia scale». Also we defined the quality of life by means of questionnaire PedsQL4.0; EEG was conducted twice: first days of hospitalization and 2 months after discharge from the hospital.

Results: we analized including of Nooclerin in the therapy of aseptic meningitis leads to significant decrease of asthenic syndrome and increase the quality of life compare to control group.

Conclusion. We recommend to include Nooclerin in standarts of management of children with aseptic meningitis.

Questions of introduction of the standard operational procedures (SOP) in medical practice and quality management of healthcare institutions are considered. Communication of SOP with standards and orders of rendering medical care in the Hospitals of children Infections is shown.
The algorithm of development of SOP in the conditions of standardization of medical care is offered. Value of SOP in the course of controlling use at introduction of strategic management of the medical organization is shown.

Rotavirus is the major cause of severe acute gastroenteritis in children under 5 years. Vaccination with a pentavalent rotavirus vaccine significantly reduces incidence of rotavirus infection.

Goal: assessment of reduction of rotavirus infection burden in case of vaccination with a pentavalent vaccine in Russian Federation.

Methods. Modeling based on results of clinical studies of rotavirus immunization and epidemiological data from Russia has been established. Analysis has been done from the position of the healthcare system (only direct medical costs) and from the social perspective (analysis of direct medical and indirect costs) with 10 years horizon. The analysis carried out for selective and routine vaccination. In case of routine vaccination herd effect has been taken into consideration. Direct medical costs were estimated based on 2013 Obligatory State Insurance tariffs in St. Petersburg.

Results and discussion. Routine vaccination can prevent 1394 cases of rotavirus infection in ambulatory settings and 686 cases of rotavirus-associated inpatient admissions per 100 000 vaccinated infants. As a whole across the Russian Federation in 10 years 2,22 million cases of rotavirus infection treated in ambulatory settings and 1.09 million of rotavirus-associated inpatients admission will be prevented. Vaccination save 1,26K rubles per child for the healthcare system of Russian Federation and 2,85K rubles per child if indirect costs are included. Annual vaccination of 95% of newborns against an rotavirus infection will allow to lower the disease burden within the first 10 years after the beginning of routine vaccination on 45,31 billion rubles, from them 18,98 billion rubles – costs of outpatient cases, and 26,33 billion rubles – costs of inpatient cases. The prevented expenses of healthcare system will make 20,04 billion rubles, the prevented indirect costs – 25,27 billion rubles.

Conclusion. Vaccination by a 5-valent vaccine against rotavirus infection not only will reduce its incidence in the Russian Federation, but also will significantly reduce costs in ambulatory and inpatient settings. Routine vaccination is economically more preferable in comparison to selected groups’ vaccination due to development of herd effect, despite need of increase in healthcare budget.

The aim of the study was to analyze and assess the real situation of HIV infection among indigenous peoples established , to investigate the prevalence of risky behavior in relation to HIV also determine the level of awareness of the indigenous population about HIV / AIDS.

Materials and Methods 1. Analysis of the data cards of the epidemical investigation hearth HIV data form number 283 «About measures on prevention of HIV , hepatitis B and C , detection and treatment of HIV» , form number 61 «Information on the groups of HIV», outpatients patient. 2. The analysis of the statistical prevalence of HIV infection among men and women , including among indigenous representatives , the structure of HIV transmission , coverage of clinical examination. 3. Data analysis of the sociological study among indigenous representatives. The proposed questionnaire contained both closed and open-ended questions to assess the risk factors of respondents’ behavior and their level of awareness of HIV infection. Evaluation of the reliability of the data performed using Student t-test. 

Results. In 2000, HIV infection in region penetrated into the population of indigenous peoples and continues to spread. Particular way of life and living conditions, such as seasonal migration within the county, early sexual activity, lack of skills in safe sexual behavior , bad habits contributed to the spread of HIV among this ethnic group. Link transition of HIV infection in a group of indigenous peoples is a high incidence of working shifts and workers, among them 30% are already infected with HIV. In connection with this, the spread of HIV infection among women occurs rapidly. Special role in the spread of HIV infection among women of indigenous peoples plays lifestyle and delated psychosocial problems.

Conclusion 1. The most vulnerable to HIV infection and sexually transmitted infections by representatives of indigenous peoples living in the national villages , due to a number of social and psychological factors. 2. In turn, representatives of indigenous peoples living in major cities and towns YaNAO more socially adapted and susceptible to preventive action. 3. In connection with developed family ties can not be ruled skid HIV in tundra communities of nomadic population. 4. Since the nomadic population inaccessible to preventive measures and insufficiently receptive to health information to control the spread of HIV epidemic process on tundra areas will be virtually impossible.

Presented clinical case describes elimination followed by seroconversion HBsAg / HBsAb patient with HBeAg-negative chronic hepatitis B on antiviral therapy with pegylated interferon α2-a and achieving sustained virological response.