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s. Shade matching is one of the most important factor in a successful and esthetically restoration. The number of mistakes made by dentists when choosing a color is 14 % (according to Barna), 9.9 % (according to Moser) and 8.2 % (according to Mc Maugh). The ability to consistently match shades accurately can help reduce the number of unsatisfactory esthetic results treatment. Matching the right color leads to a pleasing appearance and satisfaction for the patient and the clinician. Color determination in dentistry can be divided into two categories visual and instrumental. The most popular shade guides include visual classical shade the Vita Classical and are clustered into letter groups A (red-yellow), B (yellow), C (grey), D (red-yellow-gray), and chroma designated with the numerical values (e.g. A1). Used computerassisted shade analysis is more accurate and more consistent compared with human shade assessment. The objective of the study a comparative assess of the esthetic indicators of the prosthodontics treatment when determining color using visual and instrumental methods. For the period from 2015–2020 prosthodontic treatment of 158 patients with dental defects was performed. To assess the esthetic results of treatment, the patient was divided into 2 groups. In 1 group (n = 82) patients, the color determination of the prosthodontics design was carried out using standard colors according to the usual VITA scale. In 2 group (n = 76) patients, the color determination of the prosthodontics design was carried out using a color measuring device VITA Easy shade Compact. The results showed that the Vita Easy Shade machine was accurate 97.5 %, visual evaluation method was accurate 85.2 %. This study reveals that esthetic results is a significant factor in patient satisfaction, which should be evaluated. Instrumental methods for determining the color of teeth are more accurate than visual and do not depend on the subjective sensations and psychological factors of the dentist. At the moment, the combination of the Vita Easy shade system and the 3D Vita scale is the most effective in determining tooth shade or restoration. However, the instrumental method cannot replace traditional methods. Digital techniques should be a must in addition to visual analysis.

Malaria control and preventive activities in the countries of the World Health Organization Region for Europe (WHO/EUR) were strengthened within the framework of the Regional Roll Back Malaria strategy adopted by the member-states at the beginning of the 2000s. A political document “From control to malaria elimination” known as the “Tashkent Declaration” was unanimously endorsed by the member-states of the WHO/EUR with malaria problems in 2005. Since then, considerable progress has been achieved in the countries of the region, signified by the dramatic reduction of malaria incidence in conjunction with the prevention of re-establishment of infection on the territories where malaria was eliminated earlier. Several countries of the region had been certified by the WHO as free of local malaria transmission as a result of the activities of their National Malaria Elimination Programme, Armenia being one of the first in 2011. One of the main lessons learnt during the implementation of the activities by the National Malaria Elimination Programme in Armenia was that the development of an operational plan for malaria elimination required a comprehensive national effort. Full support, both political and financial, from the highest levels of government to smooth coordination between different government ministries, such as Agriculture, Defense, Finance, Health and Policy and Planning and others, was a prerequisite for operational success. The role and place of various partners in the achievement of malaria elimination in the country is discussed in this review. Electronic supplementary material The online version of this article (10.1186/s12936-019-2814-y) contains supplementary material, which is available to authorized users.

Aim. The purpose of this research was informational content assessment of the anamnestic data in diagnosing of chronic endometritis before its histologic confirmation and possibility of the timely beginning of complex therapy of pathology. Materials and methods. To achieve the aim of the retrospective analysis of 303 case reports of patients who underwent endometrium papel biopsy as a part of examination plan before assisted reproductive treatment in 2017. A particular interest, in our case, submitted the special anamnesis including consideration of menstrual, sexual and reproductive functions, past gynecologic diseases and interventions. Results. In the analysis of the received results the most constant signs of chronic endometritis: disorders of menstrual and seсretory functions; the high index of intrauterine interventions, considerable frequency of identification of endometrium polyps and the cervical channel (40,1%), pathological cervical neoplasia (30,8%) were noted. Conclusion. Thus, anamnestic data of patients with the verified endometritis, especially extended one, with inclusion of nonconventional, but relevant at the present stage additional signs, have shown high informational content for neoadjuvant diagnosis of pathology of endometrium of inflammatory character. Only against the background of timely initiated complex therapy, numerous endometrial receptivity parameters are restored, which leads to relief of clinical symptoms and lays the foundation for the successful implementation of reproductive function.

A retrospective analysis was conducted of human cases and outbreaks of tularemia in the Republic of Armenia from 1996 to 2012 utilizing geographic information system software. A total of 266 human cases of tularemia were recorded in Armenia from 1996 to 2012, with yearly incidence ranging from 0 to 5.5 cases per 100,000 people. Cases predominantly affected the male population (62.8%), 11–20 year age group (37.2%), agricultural workers (49.6%), and persons residing in rural areas (93.6%). In 2003, a waterborne outbreak involving 158 cases occurred in Kotayk Marz, and in 2007, a foodborne outbreak with 17 cases occurred in Gegharkunik Marz, attributed to exposure of food products to contaminated hay. Geospatial analysis of all cases showed that the majority were associated with the steppe vegetation zone, elevations between 1,400 and 2,300 m, and the climate zone associated with dry, warm summers, and cold winters. Characterization of these environmental factors were used to develop a predictive risk model to improve surveillance and outbreak response for tularemia in Armenia.

After brewing roasted coffee, spent coffee grounds (SCGs) are generated being one of the daily wastes emerging in dominant countries with high rate and big quantity. Escherichia coli BW25113 wild-type strain, mutants with defects in hydrogen (H2)-producing/oxidizing four hydrogenases (Hyd) (ΔhyaB ΔhybC, ΔhycE, ΔhyfG) and septuple mutant (ΔhyaB ΔhybC ΔhycA ΔfdoG ΔldhA ΔfrdC ΔaceE) were investigated by measuring change of external pH, bacterial growth and H2 production during the utilization of SCG hydrolysate. In wild type, H2 was produced with rate of 1.28 mL H2 (g sugar)−1 h−1 yielding 30.7 mL H2 (g sugar)−1 or 2.75 L (kg SCG)−1 during 24 h. In septuple mutant, H2 production yield was 72 mL H2 (g sugar)−1 with rate of 3 mL H2 (g sugar)−1 h−1. H2 generation was absent in hycE single mutant showing the main role of Hyd-3 in H2 production. During utilization of SCG wild type, specific growth rate was 0.72 ± 0.01 h−1 with biomass yield of 0.3 g L−1. Genetic modifications and control of external parameters during growth could lead to prolonged and enhanced microbiological H2 production by organic wastes, which will aid more efficiently global sustainable energy needs resulting in diversification of mobile and fixed energy sources.

After introduction of rotavirus vaccine, other pathogens might become leading causes of hospitalizations for severe diarrhea among children

BACKGROUND The Republic of Armenia was 1 of the 2 earliest countries in the Newly Independent States to introduce rotavirus vaccine into its national immunization program to reduce the burden of rotavirus disease (documented to cause 38% of acute gastroenteritis hospitalizations [AGE] among children aged

Objective The goal of this study was to identify gaps in the severe acute respiratory infection sentinel surveillance system at Surb Astvatsamayr Medical Center. Introduction Influenza is a priority in Armenia. There are two influenza surveillance systems in Armenia: population and sentinel. The medical center (MC) has been included in sentinel surveillance since 2012. In 2015 a study was undertaken to identify gaps in severe acute respiratory infection (SARI) sentinel surveillance system in Surb Astvatsamayr MC. Methods Medical records and reporting forms of SARI cases were generated for individuals meeting the case definition and analyzed for age groups, risk factors, sentinel surveillance detection methods, laboratory conformation, number of days hospitalized and reporting. Results In 2014, 3016 patients were admitted in the hospital with ARI, of whom 2982 were younger than 18 years. During the 2014-2015 influenza season (week 40, 2014-week 20, 2015), 77 swabs have been taken in total, of which five were influenza positive (4 B and 1 AH1N1). Also in the 2013-2014 influenza season, five samples tested positive (all influenza A). Sixty-one (48%) patients with respiratory disease met the WHO SARI case definition (2011), 84 (66%) of all reviewed patients would have met the SARI case definition. The numbers for the ICU (25 records reviewed) do not reflect the actual percentage of patients admitted with respiratory symptoms. The 33 additional cases taken from the sampling logbook were mainly hospitalized in the ICU. Influenza tests were performed on 34 patients (mainly ICU), five were positive for influenza (four B--all adults—and one AH1N1), and four tested positives for other respiratory pathogens (two RSV, one RV, one BV). All influenza positives had fever or a history of fever and 80% met the WHO SARI case definition (2011). Non-sampled cases generally have fewer reported symptoms, but still 44% of cases fits the WHO SARI case definition (2011). Conclusions The percentages of patients meeting the WHO SARI 2011 case definition and the WHO SARI 2014 definition shows that mainly caused by the absence of shortness of breath in the SARI 2014 definition 52% (2011) vs 66% (2014) in Surb Asvatsamayr. A large number of children from Neonatal and Children’s departments fulfil the SARI case definition and could potentially be swabbed in addition to ICU patients. There are gaps in WHO SARI case definitions. The sentinel surveillance system should be improved.

Pneumonia and diarrhea are the leading causes of child morbidity and mortality globally and are vaccine preventable. The WHO-coordinated Global Rotavirus and Invasive Bacterial Vaccine-Preventable Disease Surveillance Networks support surveillance systems across WHO regions to provide burden of disease data for countries to make evidence-based decisions about introducing vaccines and to demonstrate the impact of vaccines on disease burden. These surveillance networks help fill the gaps in data in low and middle-income countries where disease burden and risk are high but support to sustain surveillance activities and generate data is low. Through a series of country case studies, this paper reviews the successful use of surveillance data for disease caused by pneumococcus and rotavirus in informing national vaccine policy in Bangladesh, Armenia and The Gambia. The case studies delve into ways in which countries are leveraging and building capacity in existing surveillance infrastructure to monitor other diseases of concern in the country. Local institutions have been identified to play a critical role in making surveillance data available to policymakers. We recommend that countries review local or regional surveillance data in making vaccine policy decisions. Documenting use of surveillance activities can be used as advocacy tools to convince governments and external funders to invest in surveillance and make it a priority immunization activity.

Background: The poor ovarian response (POR) to ovarian stimulation significantly decreases the efficiency of assisted reproduction technologies. The genesis of POR is not well understood, and can result from various genetic and immune factors.Purpose: To determine the role of genetic (number of CGG repeats in the FMR1-gene) and autoimmune factors (anti-ovarian antibodies) in POR in IVF programs.Methods: In a cross-sectional study, 150 infertile women were divided into the POR group (n = 65) and the group with a normal ovarian response (n = 85). All the patients underwent the detection of CGG repeats in the FMR1-gene by polymerase chain reaction, serum anti-zona pellucida antibodies (AZPA) and anti-ovarian antibodies by enzyme-linked immunosorbent assay.Results: The risk of POR was higher in patients with CGG counts > 34, but not in the patients with CGG counts 34 CGG repeats.Conc...

Objective In the spring of 2014, people from vulnerable households in all marzes of Armenia were examined with the aim of active surveillance. Introduction Brucellosis is a serious disease caused by bacteria of the Brucella genus. It principally affects ruminants but may be transmitted to humans. Registration of cases in cattle farms causes considerable economic losses and creates favorable conditions for mass infection among humans. In Armenia the expansion of animal industries and urbanization are the main reasons for occurrence and development of brucellosis. Methods Blood was sampled from people on farms reported as having infected animals. Blood samples were tested by the Wright- Huddleston method. The standard case definition of brucellosis was used for diagnosis. A questionnaire-based interview was carried out among the population to identify the form of contact with animals and to analyze epidemiological links. During the investigation provisions were followed in governmental decree RA 19.01.2006 N480-N and brucellosis prevention, epidemiology, diagnosis, treatment, preventive measures. Results A total of 11160 people from 1054 households were enrolled in the study, of which 3625 (32.5%) underwent a laboratory examination. Nearly 6% (641) refused to be tested. Over 6% of those tested (226) were positive for antibodies to Brucellae. Of these, 129 (3.5%) had chronic brucellosis. Those testing positive for brucellosis were treated appropriately. These included 203 (90%) adults and 23 (10%) below 14 years old; 147 (65%) were male and 79 (35%) were female. Of those diagnosed with brucellosis, working in animal husbandry accounted for 46.6% (106), while those who harvested milk accounted for 37.6% (85) and those using raw milk made up 15.4% (35). Conclusions Cases were most frequently reported among people 20-55 years of age; the highest percentage of positives were among 41-45 year old males who had contact with infected animals. The main risk factor for acquiring brucellosis is animal husbandry.

At present, in the structure of gynecological pathology the incidence of chronic inflammatory diseases of the reproductive system reaches 60-65%, and has no tendency to decrease. Treatment of the resorts, which are located close to the place of patients' residence, is especially important for people with chronic diseases. The most terrible consequence of inflammatory diseases of the pelvic organs - is infertility, occurs as a result of tubal occlusion not less than 40% of patients.

Background: Poor ovarian response represents a major negative contribution to the efficacy of In vitro fertilization programs. It has been shown that specific nucleotide sequence variants of BMP15 gene, which encodes the growth factor specifically expressed by oocytes to regulate follicle development, are related to certain forms of ovarian dysfunction. The aim of the study was to search for novel variants related to poor ovarian response phenotypes by means of exon sequencing, and also to check possible relations of already known BMP15 variants to this particular form of ovarian insufficiency. Methods: A total of 150 patients (65 women with poor ovarian response and 85 women with normal ovarian response as a control group) participated in this retrospective case-control study. All patients received ovarian stimulation according to the protocol with follicle-stimulating hormone and gonadotropin-releasing hormone antagonist. Genotyping was carried out by polymerase chain reaction with consequent readout of melting curves by means of modified kissing probes assay. Statistical tests were two-sided, with percent values compared by χ2 test and associations measured by odds ratio. Results: Two novel single nucleotide polymorphisms of BMP15 were revealed by exon sequencing. Of these, the c.607 C>T substitution was found only in the control group. In contrast, the novel single nucleotide deletion c.-8 delC in the 5’ non-coding region of BMP15 mRNA was significantly more common in the poor ovarian response group. For the previously known sequence variants, the statistical analysis revealed associations of poor ovarian response with two single nucleotide substitutions, the exonic c.308 A>G and the intronic c.328+905 A>G. Conclusion: Two novel variants of BMP15, both of plausible clinical relevance, were found in this study. Examination of larger patient cohorts is required to further elucidate their connection with the phenomenon of poor ovarian response in In vitro fertilization programs.

We have applied GIS methodologies to create a retrospective analysis of tularemia outbreaks in the Republic of Armenia.