Mortality from pneumonias in Russia  stays  on high level with  periodical increase. In order  to study this  occurrence is necessary the  complex approach with  obligatory regards for results  of postmortem pathological investigations. In the paper  are analyzed 8 lethal  outcomes coded as pneumonias and  30 due  to influenza with different role of bacterial component. Was demonstrated that death in cases of pneumonia usually occurred in patients with severe  background pathology (alcohol abuse, chronic hepatitis etc) and in combination with  viral lesions as well. Development of bacterial complications of influenza doesn’t  correspond directly neither with the age of the patients, nor the duration of the illness  or hospitalization. In Irkutsk were  investigated 30 cases  with  the use of morphological, bacteriological, and PCR. Was  proved the  high  value  of information due  to PCR which  correlated with  clinical   and  pathological data.   Importance of  pneumococci in etiology of community acquired pneumonia was shown (11 cases versus 1 positive culture). Was assumed that the  course  of pneumonias depends upon  the  properties of their pathogen.

The  article  presents the  possible combinations of intestinal   infections of  various   etiologies, some   pathogenetic, clinical  and  epidemiological features and  problems of epidemiological surveillance and  control  of  associated infections.  Details  the  combination of typhoid fever,  shigelloses, salmonelloses, yersiniosis, pseudotuberculosis, rotavirus and norovirus infections between itself  and  other  infectious and parasitic diseases. Discusses the clinical  and  epidemiological features different combinations of intestinal infections. It is shown  that  the proportion of combined intestinal infections  can reach  to 48.9±3.3% in the structure of all associated  infections. The proportion of combination of two intestinal  infections pathogens was  29,2±6,5%, 3 agents and 10,3±4,3% and  4 pathogens and  5,9±11,6 percent. In the overall structure of the combination of intestinal anthroponoses with anthroponoses was 61,9±5,3%, anthroponoses with zoonoses was 31,1±5,0%, the other combinations (zoonoses and  zoonoses, zoonoses and  sapronoses, antroponoses with zoonoses and  sapronoses) of  7,0±9,3  percent. The  article raises  the  question of  the  need to  introduce into  existing regulatory framework the  new  scientific data  on the  whole range of features of the epidemiology of intestinal infections combined.

The link between heart disease and infectious pathogens is well known. Despite the high frequency of cardiac pathology in infectious diseases, it is rarely diagnosed because of lack of specific clinical  and  laboratory  symptoms. It is especially  difficult to diagnose in  children. Airborne  infections in the structure of infectious morbidity of children occupy a leading place.

The aim of this work was to study the nature of the lesions of the heart  in children suffering from acute infection of the respiratory tract.

Materials and  methods: 341 children with acute respiratory infection of moderate severity were surveyed by a method of ECG dispersion mapping. Cardiac  pathology has not previously been determined in these children. Signs of disease of the heart was identified in 76 children (22%). Further study included instrumental (ECG, ECHO-KG,  daily monitoring of ECG), biochemical and  etiological (ELISA, PCR, immunocytochemical) research  methods for determining the nature of the damage to the heart and the etiology of the disease.

Results. Myocarditis was diagnosed in 2%  of children, a violation of repolarization – in 21%,  heart  rhythm disorders  – in 35%  (AV – blockade in 4%).  Most  often  signs  of heart disease were detected in children with Epstein-Barr virus (32%), streptococcal (28%), cytomegalovirus (25%), herpesvirus type  6 infection (24%). Pathogens from the  group of acute respiratory virus infections were identified in 28%, enterovirus – in  10%,  Haemophilus influenzae – in  10%, Mycoplasma pneumonia – in 10%,  Pneumococcus – in 9%, Chlamydia – in 9%, Parvovirus B19 – in 6%.

Conclusion. Sensitive screening test  to  detect cardiac pathology is the method of ECG dispersion mapping. Heart damage in children with respiratory diseases in 60% of cases is associated with  mixed infections. Timely  diagnosis of lesions of the heart in infectious diseases in children allows to adjust the therapy in the early stages  and prevent the development of chronic  pathology of the heart.

Objective: to study the clinical  and  epidemiological features of brucellosis in children in the Stavropol region.

Materials and  methods: Analysis of brucellosis is made and  the  share  of brucellosis in the  Stavropol Territory  from 2010 to 2014 is clarified. The paper  used  the  data  from the Territorial  Rospotrebnadzor in  the  Stavropol Territory.  Dynamic   clinical  indices were  analyzed in  17  children with brucellosis under treatment and  dispensary observation in the  State  Budget Institution of Health  of the  Stavropol Territory  «Regional Clinical  Hospital of  Infectious Diseases». Analyzed an  outbreak of brucellosis in  Essentuki in  2016. We used  the following methods: bibliographic, monographic description, epidemiological, analytical, statistical methods.

Results. The proportion of the incidence of brucellosis in children in Stavropol Krai in comparison with the Russian figures were: in 2010 – 8,33%, in 2016 – 56%. A household way of infection increases, including children, who were infected in the  farms  of their  own  parents. The age  of infection was12–16 (47,06%), 8–11 (35,29%) and 4–7  years (17,65%).

The  main  clinical  syndromes were: arthritic, vegetative, asthenic, lymphoproliferative syndrome, liver disease, splenomegaly. Isolated forms did not occur. Predominantly, large joints with dysfunction of joints of I–II degree were affected. Late referral after the initial manifestation is typical. Late initiation of treatment. The etiotropic therapy is carried  out at least 4 weeks, in the presence of carditis – up to 16 weeks.

Conclusion. The epidemiological situation of brucellosis in the Stavropol territory  has been  tense in the recent  years. The active migration of the population from the regions of the North  Caucasus Federal  District  contributes to this.  Intensive  incidence rate of brucellosis exceeds the  average Russian level by 5–8  times  each year.

The combination of the locomotor and visceral forms prevailed  in the clinical  picture. In dynamics, within 2–7  years persistent asthenovegetative and  arthritic  changes were formed and frequent exacerbation of bacterial flora and ENT pathology of the gastrointestinal tract was observed. 

In the  Republic of Bashkortostan the  intense epidemiological  situation on HIV infection remains, spread  of a human   immunodeficiency  virus  among   the  population and augmentation of cumulative number infected and  patients continues.

Research objective: detection of nature of epidemic process  of HIV infection in the  Republic of Bashkortostan and the city of Ufa.

On  the  basis  of  medical documentation: a registration form No. 058/at “Emergency notice on an infectious disease, food poisoning, unusual reaction to an inoculation”, the card of epidemiological inspection of the center  of HIV infection, the card of an ambulatory, – 23 143 cases  of HIV infection, 5343 cases of death of HIV-positive patients were studied.

As a result of research  tendencies of spread  of HIV infection in the republic are taped: body height of number of again taped HIV-positive persons (2015 – 2 907 new cases  of HIV infection, 2014 – 2 862 case, 2013 – 2 475 cases); conservation  of a high  incidence of HIV infection (71,39 on 100 000 population); augmentation of specific gravity of a sexual way of transfer  of the HIV (51,42%) realized both at heterosexual contacts and  in group  of men  who have  sex with  men  (48 cases); growth  by 37,9% of number of the died  HIV-positive people of all reasons  and, including, owing  to HIV infection; prevalence among HIV-positive people at the time of identification  of an age category from 31 to 40 years (48,8%).

Current  situation demands acceptance of  urgent measures for stabilization and  depression of a case rate the HIV infection  including  carrying   out   scheduled  maintenance with the working population.

Diagnostics, equally with  prevention and  treatment, is a basis of medical science and practice. For its history the medicine  has accumulated a great variety  of diagnostic methods for different diseases and  pathologic conditions. Nevertheless, new  tests,  methods and  tools are being  developed and recommended to application nowadays. Such  indicators as sensitivity and  specificity which  are defined on the basis  of fourfold contingency  tables   construction or  ROC-analysis method with  ROC  – curve  modelling (Receiver operating characteristic) are used  as the  methods to estimate the  diagnostic capability. Fourfold  table  is used  with  the purpose to estimate the method which confirms or denies the diagnosis, i.e. a quality indicator. ROC-curve, being a graph, allows making the estimation of model  quality by subdivision of two classes  on the  basis  of identifying the  point  of cutting off a continuous or discrete quantitative attribute.

The method of logistic regression technique is introduced as a tool to develop some  mathematical-statistical forecasting model  of probability of the event the researcher is interested in if there are two possible variants of the outcome. The method of ROC-analysis is chosen and described in detail as a tool to estimate the  model  quality. The capabilities of the named methods are demonstrated by a real example of creation  and  efficiency estimation (sensitivity and  specificity) of a forecasting model  of probability of complication development in the form of pyodermatitis in children with  atopic dermatitis.

The  development of a stable  immunoresistance against human papillomavirus occurs  largely due  to the reactions of the innate immune system, mediated through Toll-like receptors.  It is known, that  allelic  polymorphism of the  Toll-like receptors genes, associated with  single  nucleotide polymorphisms can influence on the sensitivity of reception and lead to disruption of pathogen recognition and,  thus  lead  to reduced susceptibility of the body to infectious agents. The aim of the study was to find  the association of polymorphisms T-1237S, A2848G of TLR 9 gene, Phe-412 Leu of TLR 3 gene and С-819 Т, G-1082 A of IL-10 gene  with  persistence of human papillomavirus infection of high oncogenic types.  There were examined 194 women aged  18–42 years  with  the  presence of HPV types  16 and  18. The material for laboratory  studies were  scraped from  the  mucosa of the  urogenital tract  and peripheral blood  of patients. Depending on the  presence of virus women were divided into two groups:  98 patients with persistent human papillomavirus infection and  96  women without it. As the result  after investigation some  significant differences in the distribution of variants of polymorphic loci (A2848G)  TLR 9, (Phe412  Leu)  TLR 3 and  (G-1082A)  IL-10 were identified.

The  data  presented in the  article  deal  with  research  of hormone changes in hypophysial-paranephric system in the course  of neuroinfections. The  given  work  was  carried  out with  the  purpose of detection of dependence of the  cortisol and adrenocorticotropin hormone level on aetiology, gender, severity and  period  (cycle)  of the  disease.A comprehensive clinical  and  laboratorial checkup of 109 children with  different  nosological forms of neuroinfections was carried  out: meningitis: viral, enteroviral, purulent and  cerebromeningitis. Control board group was composed of 10 healthy children of the identical age. All the patients underwent the Adrenocorticotropin Hormone and  Cortisol  blood  serum  level,  IFA technique being  used,  during acuity and  reconvalesence. It has  been  determined that  in  case  of neuroinfections  irrrespective of the ethiology, hypophysis trophic funtction undergoes arrest during the whole disease period. While studying adrenal gland  functioning during the  acuity the  increased cortisol secretion is observed, the degree of which  is authentically  higher  in case  of purulent meningitis and  meningoencephalitis compared to hydromeningitis. On recovery  the cortisol values decrease to healthy children’s level. A reliable dependence of the  ACTH  and  cortisol  level  on the  severity degree in case of purulent meningitis and meningoencephalitis was discovered ( brought to light). It is also satisfactorily brought to light that ACTH and cortisol levels depend on the severity degree in case of purulent meningitis and meningoencephalitis. It is proved that adrenal gland  system function does  not depend on the patients’ gender and  age in case of neuroinfections.

Objective: analysis of pathogenetic and  symptomatic therapy of community-acquired pneumonia in the prehospital and at the stage  of hospital treatment of disease in hospitals of city Khujand of the Republic of Tajikistan.

Materials and  methods: A retrospective analysis of 393 case  histories of  patients treated for  community-acquired pneumonia in  the  hospital Khujand from  2011  to  2015  is conducted. The estimation of the scope  and efficiency of the additional medical support for the treatment of communityacquired pneumonia was conducted, take  into  account the drugs  that  given  to patients in an outpatient setting and  in a hospital. Analyzed purpose rationale, adequacy of dose, duration of treatment and  compliance of the  activities with existing international and  national guidelines for the treatment  of community-acquired pneumonia.

Results:  the  study found that  in  clinical  practice, 57% of  patients with  community-acquired pneumonia received funds pathogenetic and  symptomatic therapy. It  is  found that  quite  often  prescribed drugs  with  unproven efficiency. Thus,  75%  of patients received expectorants and  mucolytic drugs,   42.2% of  patients  received anti-allergic medicals. Non-steroidal anti-inflammatory medicals received 37.9% of patients with  community-acquired pneumonia, almost  30% of patients receiving infusion therapy. Quite often  (15.7%) patients with   community-acquired  pneumonia  prescribed antifungal drugs  and  antiprotozoal drug  – metronidazole (59%  of cases).  Furthermore, in complex treatment of community-acquired pneumonia include vitamin C (23.1%) and vitamin B (65.9%).

Conclusion: the  analysis of pharmacotherapy community-acquired pneumonia showed that  in the treatment of this disease occurs  unjustified polypharmacy. Quite often  prescribe drugs with unproven efficacy and, as a consequence of a significant frequency of clinical  failures  at both the outpatient  and  inpatient, which  significantly increases the cost of treatment. From the standpoint of evidence-based medicine is justified by the  inclusion in the  treatment of communityacquired pneumonia, only a mucolytic drugs and indications NSAIDs as an antipyretic and analgesic short course. The use of most drugs of pathogenic therapy do not have the evidence base  and  the  efficiency of their  purpose can not  be considered reasonable. In this case, the analysis can serve as a basis for planning a set of measures for improvement of pharmacotherapy community-acquired pneumonia based on the principle of minimal sufficiency. 

The objective: examine markers  of endothelial activation in complicated and uncomplicated forms of influenza in children.

Materials and methods. The method of ELISA carried  out in serum study in 114 children with uncomplicated influenza A H1N1pdm09 and  87 children with  pneumonia associated with influenza virus A H1N1pdm09 some markers  characterizing  the endothelial dysfunction.

Results of research. It was found that the figures nitroxide producing endothelial function, the  content of endothelin, von Willebrand factor antigen and  functional activity in the serum of patients with a mild form of influenza A H1N1pdm09 not differ from the control values.  Levels of endothelin, nitric oxide metabolites, von Willebrand factor  antigen and  functional  activity were increased in children with  development of  severe   and  complicated course  of  influenza A H1N1pdm09, maximizing in severe viral and bacterial pneumonia.

Conclusion. The development of endothelial dysfunction is a key  pathogenesis links  the formation of heavy  and  complicated forms of influenza A H1N1pdm09 children.

Objectives. To provide clinical  and laboratory  characteristics of chronic  hepatitis C in Vietnam.

Materials and  methods. A retrospective analysis of data about  1870 HCV  patients observed at Hepatology Clinic  in Ho Chi Minh  City, Vietnam from 2010 to 2015.

Results. Among observed patients, HCV  genotype 1 is predominant (48.8%), genotype 6 was  registered in 29,7% of patients, and genotype 2 – 18,7%. Advanced fibrosis (F3) and cirrhosis (F4) were detected in 52% of patients. The rate of chronic  co-infection with  hepatitis B viruse  and  hepatitis C virus is at 6% of patients. Nearly  one-tenth of all observed HCV patients (9%)  were diagnosed with hepatocellular carcinoma. In the  group  of patients who completed the  full course  of treatment, non-responsers to therapy and  have  virologic  breakthrough, SVR-24  was registered at 73,7% and 75,1% of patients treated with  simple or pegylated interferon, respectively. Thus,  combination therapy with interferonalpha  and  ribavirin  for the  indigenous Vietnamese population has been showed relatively high efficiency.

Conclusion. The  findings about  clinical  and  laboratory characteristics of patients with  chronic  hepatitis C, and  the effectiveness of antiviral therapy, have practical importance for preparation a long-term strategy for the  elimination of hepatitis C in Vietnam.

Analyzed organization of preventive measures and  patient  care  in  Velikiy Novgorod in  connection with  the  exceeding of the  epidemic threshold for influenza and  acute respiratory viral  infections in  2016.  The  epidemic rise  of influenza and  other  acute  respiratory viral  infections exceeded epidemiological and economic thresholds among  the cumulative population on the  territory  of the  Novgorod region started from the 3rd week 2016 (18.01.2016–24.01.2016) and continued for 4 weeks (until  mid February).  The peak  of the epidemic was passed on the 4th calendar week  of 2016, when  the weekly prevalence rate was 135,7 per 10 thousand population (8447),  the  epidemic  threshold was  exceeded in 2 times. In terms  of conversion to the  infectious diseases hospital, a multidisciplinary clinic № 2 «Central city clinical hospital» carried  out specialized medical assistance 301 the patient with  acute respiratory diseases and  influenza, 67 of which were confirmed influenza caused by the H1N1 virus, of which  28 patients would,  if hospitalized in serious  and critical condition and  needed to be held-Institute the  intensive care manual.

The article presents an analysis of a clinical  case of a patient  of 76 years, describes the key links  in the pathogenesis of Kaposi’s  sarcoma  virus,  and  the  modern concept of participation in the pathogenesis of the disease. A feature of this clinical  observation was the  development of the  disease on the background of the functional immunosuppression, which developed because of old age. Besides the standard protocol of conducting a similar  profile  of patients therapy led to the development of side  effects. In turn,  the optimization of the therapeutic protocol  has  allowed to avoid  side  effects from the  treatment, continue therapy led  to  complete convalescence.

The introduction of new immunological tests (test with Diaskintest) enables timely, but refer the child for examination in phthisiopulmonology the presence of comorbidity. A clinical case of combined pathology of the lungs  of a 13-year-old child with a polo-positive result with samples Diaskintest, the presence of clinical  symptoms and  radiographic changes in the lungs.  The patient entered the clinic of the Institute after five  years  of observation and  treatment failures  pulmonologist with suspected tuberculosis after five years of the lower lobe of the left lung in the phase  of destruction and contamination to examination in order to clarify the diagnosis and a course  of specific therapy. A child  with  concurrent chronic bronchopulmonary pathology was  diagnosed lung  TB. The need for a detailed and  comprehensive study of the  history of the disease, the use of a complex of modern methods of inspection and timely solution of millet  Prompt intervention is determined in a subsequent treatment efficacy, minimal residual  changes and restore the functional state  of the child’s body.

Aim.  Analysis of phylogenetic relationships of HIV  isolates obtained from a child 8 years old and HIV-positive parents to search for a possible source of infection.

Materials and  methods. The  blood  plasma  samples of 3 patients (father, mother and child) HIV from Veliky Novgorod were used.  Presented in a group of patients were directed to conduct epidemiological investigation cases  of HIV-1 infection a child from a dysfunctional family.  In the present study we used  genotyping by direct  sequencing of the  site  of the polymerase gene  (pol) length of 1285 nt., The gene  encoding the protease (PR) length of 465 nt. and a portion of the reverse transcriptase (RT) gene length of 820 nt.

Results. The study allowed the  identification of the  HIV virus in clinical  samples. HIV-1 subtype A1 (IDU-A) was detected in all cases.  Phylogenetic analysis of isolates, where the  control  samples using   HIV-1  isolates obtained  previously  from Veliky Novgorod, possible to identify grouped in a separate cluster  sample from the mother, father  and  child, which  makes it possible to conclude about  intrafamily HIV infected child  by  one  of his  parents. The  nucleotide identity  of the  samples obtained from the  mother  and  the  child, showed a higher percentage of similarity – 98.4%, compared with  the  identity of the  samples between the  father  and  the mother  and between father and child (96.2% and 94.2%, respectively). Differences natural  polymorphisms in  protease and reverse  transcriptase genes  of the parents and  the child are discussed.

Conclusion. The analysis of phylogenetic relationships of HIV isolates showed that the source  of infection of the child 8 years old, born and  living  in socially  disadvantaged families with HIV-positive parents, is his mother. Way parenteral transmission of infection by random simultaneous trauma  in the mother  and child.

Molecular phylogenetic analysis using  routine methods for determining the resistance of HIV to antiretroviral drugs allows  to investigate cases  of HIV infection, identifying the source of infection.