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Aim: To optimize a system of medical care, introduction of treatment and diagnostic guidelines, including secondary stroke prevention and rehabilitation measures, by implementation of pediatric stroke registry., Material and Methods: Fifty-seven patients, aged from 1 year to 17 years 11 months, included into the Moscow city registry of pediatric stroke were examined. Forty-two patients suffered ischemic stroke and 15 hemorrhagic stroke., Results and Conclusion: The diagnostic search for the causes of pediatric stroke is difficult due to the wide variety of etiologic factors and high frequency of their combinations. This confirms the necessity of multidisciplinary approach to the management of children and adolescents in the acute phase of stroke in a multiprofile hospital with the following specialized ambulatory care.

The paper presents the assessment of tooth decay prevalence in clinically homogenous groups of children receiving long-term preventive program (PP) in school dental facilities. Five-years PP were introduced in clinical practice in 2 Moscow schools. Preventive treatment was performed by dental hygienist. The results show that systematic preventive treatment in school dental offices starting from elementary school allows reducing dental caries incidence 46-53% and stabilize the incidence of caries complications. It should be mentioned though that analysis of individualized outcomes proves heterogeneity of study results despite of equal conditions of PP. Potentially significant hence is early diagnostics and treatment of initial caries forms as demineralization foci, especially in children with intensive tooth decay. Optimization of pediatric dentist and dental hygienist activity in school dental facilities is the main factor of caries prevention efficiency.

There are considered special social and economic aspects of the epidemiology of Helicobacter pylori. These aspects acquired the particular importance for the last time due to the fact that the provision of the people with pure water has been becoming the focus of the attention of geopolitical and socio-economic interests in a number of countries. The availability ofpure drinking water serves a marker of the socio-economic state of the territory and the population living there. In Russia where different climatic conditions are deposited by considerable regional differences in the conditions of communal services caused both by various level of the socio-economic development of the territory, the supplementation with pure drinking water serves as the social determinant of the ecological conditions of the population’s life. This particularly has impact on the unfeasible technical state of the water distribution systems, microorganism ecology of which can substantially affect public health. The performed by authors a specialized screening ofpresented at the official web site of the joint-stock company «Mosvodokanal» current data concerning the quality of drinking water consumed by 2500 Moscovites, tested for the Helicobacter pylori infection revealed no deviations from the sanitary standards in the water received by the consumers. Along with that, the comparison of the map documents of the distribution of the Helicobacter pylori infection in Moscow with the distribution of citizens’ complaints of the decline of the quality of tap water has revealed a territorial fastening of the high values of the population infection rate of n^ylori and the urban sites with the greatest number of complaints. In the microbial ecology of water-distribution systems there are tightly aligned problems of their epidemiological safety, technical state and economic damage caused by corrosion as a result of microbiotic activity. In contrast to acute bacterial and viral infections which are deemed of the greatest importance when assessing the sanitary condition of water sources and water-distribution systems, the consequences of infection with H. pylori may not be manifestedfor a long time but some years later they may be manifested as serious chronic diseases (from gastritis to adenocarcinoma of the stomach and a wide range of extraintestinal pathologies), which causes great social and economic losses. Thus, the socio-economic aspect of the epidemiology of helicobacteriosis includes at least two components: the technic - the maintenance of the feasible technic and sanitary state of the water distribution systems and the medico-social - expenditures for screening and treatment of infected patients. In total they are an inseparable part of the prevention of socially-important diseases in the public health system.

The article presents an analysis of births after treatment for breast cancer in women of reproductive age. In details there is described this group of patients based on a retrospective analysis of case histories. Eight patients, included in this study, received anti-cancer treatment between 2000 and 2009. All pregnancies appeared on their own without the use of supporting reproductive technologies. There are presented oncological and reproductive outcomes. The discussion includes data of literature on the possibility of pregnancy after breast cancer treatment.

Approximately a quarter of the world's population at some point in life is at risk of developing shingles (Herpes Zoster). In 10-20% of cases the first branch of the trigeminal nerve gets involved (Herpes Zoster Ophthalmicus, HZO). Ophthalmic complications of HZO are able to cause a significant reduction in visual function., Aim: To study and summarize clinical features of HZO (including the rate of complications and their nature) and to determine the relationship between clinical and laboratory data from these patients., Material and Methods: The study included 133 patients with ophthalmic and neurological complications of HZO (group 1 (n=28) - retrospective analysis of outpatient records for the period 1995-2005; group 2 (n=95) - a prospective study for the period 2005-2015), who received a course of conservative treatment in either the Botkin City Hospital, branch № 1, or in the ophthalmic department of the Moscow herpes centre (Gerpeticheskiy Tsentr Ltd.). Laboratory tests were performed only in patients from group 2 and included: examination of biological fluids for six types of herpes viruses by polymerase chain reaction, examination of tears and urine for DNA of Chlamydia, Mycoplasma, and Ureaplasma, and serological blood testing for markers of herpes virus infection. Patients from group 1 were prescribed topical antiviral, antibacterial, and anti-inflammatory therapy, in rare cases - acyclovir per os. In group 2, the treatment included systemic antiviral medications and immune correction therapy. Anti-inflammatory therapy consisted of local and systemic non-steroidal agents (NSAIDs)., Results: The most common ophthalmic complications of HZO in both groups were stromal keratitis and keratoiridocyclitis, neurological - III and VI cranial nerves palsies. The duration of the disease in the first group ranged from 2 months to 3 years; in the second group, patients were divided into two subgroups: subgroup A with the disease duration of no more than one month (n=81) and subgroup B with the disease duration from 1.5 to 9 months (n=14). Varicella-zoster virus (VZV) DNA was present in tears and/or other biological fluids of patients from group 2 in more than 70% of cases (n=67). Particularly, in 27.4% of cases the virus was isolated in two fluids and in 7.4% of cases - in three fluids. The duration of virus production in tears and other biological fluids (saliva, blood, and urine) ranged from 10 days to 4 months., Conclusion: Topical non-steroidal anti-inflammatory drugs and systemic etiological treatment in case of intraocular inflammation in HZO patients may reduce the risk of severe consequences of VZV reactivation and help avoid recurrences later in life.

Aim: To analyze the results of laparo- and thoracoscopy in patients with thoracic and abdominal trauma in conditions of emergency hospital., Material and Methods: For the period 2006-2013 we performed 56 laparoscopic and 15 thoracoscopic interventions in 67 patients with trauma. There were 80.6% of men and 19.4% of women aged 35±1.7 years. Abdominal, thoracic and thoraco-abdominal injuries were observed in 51 (76.1%), 14 (20.9%) and 2 (3%) patients. Abdominal or thoracic trauma alone was diagnosed in 41 (61.2%) cases and combined injury - in 26 (38.8%) patients. 37 (66%) interventions were performed laparoscopically. Conversion to laparotomy was observed in 19 (34%) cases. Mean volume of hemoperitoneum was 458 ml (range 100-1100 ml). In 11 (73.3%) patients thoracoscopic surgery was performed and conversion of access was applied in 4 (26.7%) cases., Results: No injuries of internal organs were observed in 19.6% and 13.3% of patients using laparo- and thoracoscopy respectively. So inadvisable open surgery was prevented although formal indications for laparo- and thoracotomy were present. In 25% and 20% of abdominal and thoracic damages respectively we avoided relatively unjustified laparo- or thoracotomy because of injuries were cured endoscopically. No one missed injury was observed. Postoperative complications were diagnosed in 5.6% of cases. Mortality rate was 15.6% in case of severe combined trauma. Mean hospital stay was 23.2 days (range 3-105)., Conclusion: Endoscopic techniques are perspective in treatment of thoracic and abdominal trauma. It allows to avoid inadvisable laparo- and thoracotomy in some cases and to improve results of treatment.

Aim: Characterize spectrum of antibiotics resistance of Acinetobacter baumannii strains, isolated from patients of 8 surgical and reanimation departments of 3 medical institution of Moscow, and determine molecular-genetic mechanisms of stability of their carbapenem-resistant forms., Materials and Methods: 95 strains of A. baumannii, isolated from patients of reanimation and surgical departments of Moscow in 2012-2014, were studied. Sensitivity of strains to antibiotics was tested phenotypically according to recommendations of EUCAST. The presence of VIM, IMP, OXA-23, OXA-40, OXA-48, OXA-58 and NDM genes in the studied strains was determined by polymerase chain reaction in real time., Results: 86.3% of strains turnedout to be non-sensitive to carbapenems, sensitive--13.7%. 80.0% of strains were non-sensitive to gentamicin, 80.0% of strains--to netilmicin, 94.7% of strains--to ciprofloxacin 2.1%--to colistin. 91.6% of isolates have shown non-sensitivity to members of 2 and more classes of antibiotics, 78.9% of strains--to members of 3 classes. 2 strains were panresistant, 4.2% (4/95) of the isolates were sensitive to all the classes of antibiotics. Metallo-β-lactamases were not detected. Genes of carbapenemases (OXA-23 and/or OXA-40) were detected in 85.3% (81/95) of strains, characterized phenotypically as non-sensitive to carbapenems., Conclusion: The results obtained shown an increase of resistance to carbapenems and multiple resistance in clinically significant strains of A. baumannii. Resistance to carbapenems is associated with OXA-23 and OXA-40 genes. The conclusions allow to justify perspectives of introduction of technologies of molecular-genetic testing of antibiotics resistance.

The increasing chemicalization of production and life leads to the pollution of water bodies by chemicals, the effect of which on the micro - and macro - organisms is poorly understood. This section of the study in sanitary bacteriology is becoming ever more topical and is an important task of modern hygienic science. One of complicacies of the study of the problem is related with the fact that the presence of only experimental data fails to be sufficient, as the impact of any given chemical substance on different bacteria in the experiment does not mean that under natural conditions, similar results will be obtained. One reason for this may be the inhibitory effect of the given chemical on biological properties of bacteria, while in field conditions in the water several chemicals interacting with each other can exist. In this regard, the aim of the work was to assess the indicator value of sanitary and microbiological indices of epidemic hazard of water use in conditions of chemical pollution of surface water bodies.

Background: The spread of carbapenemase-producing Enterobacteriaceae (CPE) is a great problem of healthcare worldwide. Study of the spread for bla OXA-48-like genes coding epidemically significant carbapenemases among hospital pathogens is important for the regional and global epidemiology of antimicrobial resistance., Methods: Antibacterial resistant isolates of Klebsiella pneumoniae (n = 95) from 54 patients, P. mirabilis (n = 32) from 20 patients, Enterobacter aerogenes (n = 6) from four patients, and Enterobacter cloacae (n = 4) from four patients were collected from January, 2013 to October, 2014 in neurosurgical intensive care unit (ICU) of the Burdenko Neurosurgery Institute, Moscow. Characteristics of the isolates were done using susceptibility tests, PCR detection of the resistance genes, genotyping, conjugation, DNA sequencing, and bioinformatic analysis., Results: Major strains under study were multi drug resistant (MDR), resistant to three or more functional classes of drugs simultaneously-98.9 % K. pneumoniae, 100 % P. mirabilis, one E. aerogenes isolate, and one E. cloacae isolate. Molecular-genetic mechanism of MDR in K. pneumoniae and P. mirabilis isolates were based on carrying of epidemic extended-spectrum beta-lactamase bla CTX-M-15 gene (87.2 and 90.6 % accordingly), carbapenemase bla OXA-48-like gene (55.3 and 23.3 % accordingly), and class 1 (54.8 and 31.3 % accordingly) and class 2 (90.6 % P. mirabilis) integrons. The bla OXA-48-like-positive K. pneumoniae were collected during whole two-year surveillance period, while P. mirabilis and Enterobacter spp. carrying bla OXA-48-like genes were detected only after four and 18 months after the research start, respectively. The bla OXA-48-like gene acquisition was shown for P. mirabilis isolates collected from five patients and for E. cloacae isolate collected from one patient during their stay in the ICU, presumably from bla OXA-48-like-positive K. pneumoniae. The source of the bla OXA-244 gene acquired by E. aerogenes isolates and the time of this event were not recognized., Conclusions: The expanding of CPE in the surveyed ICU was associated with the spread of bla OXA-48 and bla OXA-244 carbapenemase genes documented not only among K. pneumoniae, well-known bacterial host for such genes, but among P. mirabilis, E. aerogenes, and E. cloacae.

The objective of the present study was the retrospective analysis of the cases of rapid diagnostics of the HIV status of the corpses referred to the pathologo-anatomical departments of Moscow. The standard statistical methods were used for this purpose. The structure of H IV infections is described in terms of age and sex of the affected subjects as well as stages of the disease. It was shown that cooperation of forensic medical services with AIDS control and prevention centres is of primary importance for the substantiation of the diagnosis, improvement of the quality of the relevant statistical information about the causes of death, enhancement of the objective value of epldemiological data on the occurrence of HIV infection and HIV-associated diseases in the city of Moscow.

Objectives: To determine the health status of athletes before the start of an international athletics championship and to determine whether preparticipation risk factors predicted in-championship injuries., Methods: At the beginning of the 2013 International Association of Athletics Federations (IAAF) World Championships, all registered athletes (n=1784) were invited to complete a preparticipation health questionnaire (PHQ) on health status during the month preceding the championships. New injuries that occurred at the championships were prospectively recorded., Results: The PHQ was completed by 698 (39%) athletes; 204 (29.2%) reported an injury complaint during the month before the championships. The most common mode of onset of preparticipation injury complaints was gradual (43.6%). Forty-nine athletes in the study reported at least one injury during the championships. Athletes who reported a preparticipation injury complaint were at twofold increased risk for an in-championship injury (OR=2.09; 95% CI 1.16 to 3.77); p=0.014). Those who reported a preparticipation gradual-onset injury complaint were at an almost fourfold increased risk for an in-championship time-loss injury (OR=3.92; 95% CI 1.69 to 9.08); p=0.001). Importantly, the preparticipation injury complaint severity score was associated with the risk of sustaining an in-championship injury (OR=1.14; 95% CI 1.06 to 1.22); p=0.001)., Summary and Conclusions: About one-third of the athletes participating in the study reported an injury complaint during the month before the championships, which represented a risk factor for sustaining an injury during the championship. This study emphasises the importance of the PHQ as a screening tool to identify athletes at risk of injuries before international championships., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

As millions of people worldwide are expoed to inorganic lead, both in the workplace and in general environment, its potential carcinogenicity is an important health problem. Although lead has been shown to be carcinogenic in laboratory animals, epidemiological studies have been inconclusive, and the relationship between lead and human cancer is still unclear. There were several limitations that complicated the analysis and evaluation of the carcinogenic potential of lead compounds. In particular, many of the cohort studies of lead and cancer, mostly among heavily lead-exposed workers, have been limited by a failure to identify and control for covariates, especially co-exposures to other metals such as arsenic, cadmium, and chromium, which have been shown to be carcinogenic. Most of the epidemiological studies unfortunately do not have data on dose-response. The scientific merit of our study is the virtual absence of confounding by other known carcinogens. Another advantage of our study is the presence of three occupational sub-cohorts with different levels and routes of lead exposure. Most previous studies have data on dose-response provided only by comparisons of exposed to unexposed persons. In summary, the results of this cohort study suggest that occupational exposure to lead may increase the risk of cancers of the pancreas, kidney and rectum. In conclusion, despite several limitations, the results of our study add to the evidence that carcinogenicity to humans may be an additional adverse health effect of lead.

Objectives: To report the long-term effect (18 years) of the Nexö-method, initially implemented in groups of children in Moscow in 1994., Methods: Three groups of children were included in the initial study in 1994. This study is a follow-up study of two of the three initial groups: a group of 6-year-olds (test group6 ; control group6 ) and a group of 11-year-olds (test group11 , control group11) , n = 50 individuals in each of the four subgroups. In 2012, >80% of the participants in the two groups (now aged 24 and 28 years old) were re-examined by the original examiner, who was blinded to which group the patients had belonged in the initial study. After re-examination, the participants were interviewed by a person not otherwise attached to the study. Finally, caries data were collected from 100 24-year-olds and 100 28-year-olds who attended the dental school (50%) and private clinic (50%) in Moscow (External control groups24,28 ). The outcome variables of the study were plaque and gingival status, and DMFT/S., Results: In 2012, the control groups24,28 displayed significantly higher plaque scores than the test groups24,28 (P-values < 0.05). No differences were seen regarding gingivitis scores (P-values > 0.41). Mean DMFT/S in 2012 was test group24 = 6.98/10.51, control group24 = 8.84/13.14 (P = 0.02/0.06). External control group24 = 8.89/15.86 (test24 versus external control group24 , P = 0.01/0.007; control24 versus external control group24 , P = 0.94/0.16). Test group28 = 6.74/10.83, control group28 = 8.70/14.48 (P = 0.02/0.008). External control group28 = 9.03/18.06 (test28 versus external control28 , P = 0.03/0.001; control28 versus external control28 , P = 0.68/0.07). The interview indicated that the participants in the test groups were more aware of factors that are considered important for control of caries than participants in the control groups., Conclusions: The data from this group of Moscow citizens suggest a long-term positive effect of the Nexö-method implemented during childhood., (© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Our first experience in genotyping Giardia from Moscow residents, has shown that 4 and 2 of seven samples belong to G. duodenalis genotype A and genotype B, respectively; one sample was negative during amplification with two types of primers. Genotyping was Carried out using the specific primers TPIA and TPIB to the gene encoding for the enzyme triosephosphate isomerase from the parasite. Thus, further such investigations using a larger number of samples will be able to complement the epidemiology of Lamblia infection in Moscow residents.

The prevalence of toxocariasis was studied among a population of domestic and stray dogs and cats. In a megalopolis, Toxocara invasion was 31.6% in a population of cats and 82 and 25.4% in that of puppies and dogs, respectively. A method was developed for the molecular genetic identification of T. cati and T. canis.

Anal human papillomavirus (HPV) is prevalent among men who have sex with men (MSM), but has not been studied in the Russian Federation. A cross-sectional survey and HPV genotyping were conducted among HIV seropositive (n=58) and seronegative MSM (n=65)in Moscow. Multivariable logistic regression was performed to identify correlates of infection with oncogenic HPV genotypes 16 and/or 18 (HPV 16/18). Forty per cent (49/124) of all MSM were infected with at least one anal HPV genotype, 31.5% (39/124) had HPV16/18,and 11.5% (14/121) had high-grade squamous intraepithelial lesions (HSIL). HPV 16/18 was more prevalent in HIV seropositive than seronegative men (24/58,41.4% vs 15/65, 23.1%; p=0.03). HIV infection was independently associated with HPV 16/18 (adjusted odds ratio (AOR): 5.08; 95% confidence intervals (CI):1.49-17.34, p=0.01), as was having 2-4 steady male sex partners in the last year (vs ≤ 1 partner; AOR: 6.99;95%CI: 1.94–25.24, p<0.01). History of prison/detention,migration to/within Russia and use of incompatible lubricants were marginally associated with HPV16/18 (p<0.10). Comprehensive prevention options are needed to address HIV and HPV infection among MSM in Russia and may benefit from inclusion of young men in piloted HPV vaccination programmes.

Aim: Evaluation of the role of contemporary methods in epidemic control of brucellosis outbreaks among employees of auxiliary facilities in Moscow zoo nursery., Materials and Methods: During 2003-2013, biannually, sera from more than 200 employees of the nursery, that work during periods of epizootics of small and large cattle in nursery auxiliary facilities, were studied. A complex of laboratory methods for brucellosis was used: variations of traditional serologic agglutination method in tubes--Wright's reaction (WR), on glass--Huddleston's reaction, Coombs' anti-globulin reaction; enzyme immunoassay with immune-dominant S-LPS; realtime polymerase chain reaction with primers based on genus target of BCSP31 protein gene., Results: After eradication of sheep brucellosis in 2003, the percentage of nursery facility employees, that react positively to brucellosis, has decreased from 42.7% to 15.9-17.2% in 2005-2006. RT-PCR detected human infection during epizootics 5.8 times more effectively compared with EIA. The repetition of the brucellosis epizootics in 2007 and 2009 among large cattle and a 2-year yak had initiated a rise in infection rate among employees, that had not previously (2003-2006) reacted to brucellosis. Acute clinical forms of brucellosis were not detected in 2012-2013 and antibody titers in EIA in previously infected employees have decreased in the absence ofbrucellosis epizootics in the nursery. 30 employees, infected with brucellosis causative agent, were detected for the entire period of examination, among those 10 individuals had developed clinical forms of brucellosis (6--acute, 4--chronic)., Conclusion: Epidemic control for 11 years, based on a complex of laboratory methods, allowed to register infection and outbreaks of brucellosis in the nursery employees during epizootics of 2003, 2007 and 2009. RT-PCR--effective method of detection of infection in humans during brucellosis periods in the nursery. EIA--sensitive method during chronic forms of brucellosis in the periods between and after epizootics compared with RT-PCR. A variation of a traditional serologic method of diagnostics has shown a lower sensitivity, informativity with a larger duration of analysis compared with RT-PCR and EIA.

Background: We aimed to describe bacterial etiology of acute otitis media (AOM) and characterize resistance, serotypes and genotype profiles of AOM-causing pneumococci recovered in Moscow children., Methods: Children with AOM and an available middle ear fluid specimen were prospectively enrolled in this study. Streptococcus pneumoniae, Streptococcus pyogenes, Haemophilus influenzae and Moraxella catarrhalis were considered as true otopathogens. All pneumococcal isolates were serotyped using the Quellung reaction; multidrug-resistant (MDR) pneumococci underwent multilocus sequence typing., Results: In 172 of 541 enrolled AOM patients (32%) at least 1 otopathogen was recovered, with S. pneumoniae having the highest rate of 63% (109/172). When adjusted for antibiotic treatment before sampling, in untreated patients the rate of culture-positive AOM was 35% (124/352), S. pneumoniae had a prevalence of 69% (86/124), S. pyogenes 19% (24/124), H. influenzae 13% (16/124) and M. catarrhalis 9% (11/124). Among 107 examined pneumococci, 45% were penicillin-nonsusceptible, 34 and 30% were resistant to erythromycin and clindamycin, respectively; 30% had an MDR phenotype, but no amoxicillin-resistant isolates were found. Ten of 32 (31%) MDR pneumococci related to clonal complex 320, the remaining isolates belonged to 7 different clonal complex. Six leading serotypes were 19F (27%), 3 (12%), 6B (11%), 14 (11%), 19A (9%) and 23F (8%); overall polysaccharide conjugate vaccine13 coverage was 93%., Conclusions: S. pneumoniae, the leading bacterial AOM pathogen in Moscow children, is characterized by a substantial rate of antibiotic nonsusceptibility and clonality. A polysaccharide conjugate vaccine with expanded coverage seems to fit the current AOM pneumococcal serotype distribution in Russia better.

For the purpose of investigating Behcet's disease (BD) in Russia, 250 consecutive patients (177 men and 73 women) diagnosed with BD between 1990 and 2010 at the Research Institute of Rheumatology, Russian Academy of Medical Sciences in Moscow were enrolled in this study. The ethnic backgrounds of the patients were reported as follows: 23.2% (58 cases) from Russia, 12.8% (32 cases) from Azerbaijan, 14.4% (36 cases) from Armenia, 8.8% (22 cases) from Chechnya, and 21.6% (55 cases) from Dagestan. The remaining 19.2% (48 cases) were from other regions or of unknown origin. More than half (57.6%) of the Behcet's disease patients originated from Central Asia, specifically Azerbaijan, Armenia, Chechnya, and Dagestan. The mean age at disease onset was 31.5 ± 9.38 (13-60) years old, and the most typical initial manifestations were oral aphthous ulcers. Patients aged 20-39 years old were more commonly affected and displayed a wide clinical spectrum of the disease, with varieties of severe internal organ involvement. The manifestations observed throughout the course of the disease included oral aphthous ulcers (100%), various cutaneous lesions (88.8%), genital ulcers (81.2%), and ocular lesions (54.0%). Besides these, many organs/systems were implicated in patient cases, namely joint (53.2%), vascular (25.2%), neurological (8.0%), gastrointestinal (25.2%), and cardiac (5.6%) systems. Involvements of ocular (p < 0.01) and skin (p < 0.01) lesions were more frequent in men than in women. HLA-B51 and HLA-A26 typing was performed in 127 patients and 508 healthy controls. HLA-B51 was found in 63.0% of BD patients compared to 20.7% of the healthy control subjects (p < 0.001), and HLA-A26 was present in 11.3% of BD patients and 18.9% of the control group. This study shows the presence of BD in Russia, and it is suggested that its prevalence in Central Asian people is much higher than that in White Russian.

Aim: To estimate the incidence of acute myeloid leukemias (AML) in Moscow adults and to evaluate the efficiency of their treatment., Subjects and Methods: Data on Moscow residents who were first diagnosed with AML in 2010 were retrospectively collected. The efficiency of their treatment was evaluated from the rates of complete remissions (CR), recurrences, deaths, and 4-year overall (OS) and relapse-free survival (RFS). The data as of September 1, 2013, were analyzed., Results: According to the 2010 pooled materials of the city's municipal hematology departments, AML (non-M3 types) was diagnosed in 286 patients whose median age at diagnosis was 64.9 years (range, 18.2-92.0 years). The notified incidence rate was 2.9 (3.3 for men and 2.6 for women) cases per 100,000 population. 118 (41%) patients received intensive chemotherapy (ICT); 119 (42%) had chemotherapy with low-dose cytarabine (LDC); 7 (2%) had that with hypomethylating agents (HA); and 42 (15%) had palliative therapy (PT). During first-line therapy, none of the patients underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT). In the entire group, the early (within the first 60 days) mortality rates were 42% (119 deaths); that of patients with primary refractory disease was 32% (90 deaths). CR was achieved in 77 (27%) patients: 57 (48%) on ICT, 17 (14%) on LDC, and 3 (43%) on HA. Recurrences occurred in 37 (48%) of the 77 patients who had achieved CR at a median follow-up of 43.9 months. Four-year OS in all the patients receiving PT was 9.8±1.9% (18.2±3.9% in the patients on ICT versus 4.5±2% in those of LDC; p=0.028); 4-year RFS was 36.1±5.7% (39.6±6.7% inthe patients on ICT versus 31.3±11 .6% in those on LDC; p=0.8)., Conclusion: High mortality rates in the induction, which are caused by the limited resources of accompanying therapy, poor sanitary conditions, and no own opportunities to perform allo-HSCT, remain a key problem of AML therapy in adults.

1112 people from Moscow region have been surveyed. Genotyping of rs659366 polymorphism UCP2 gene was performed using allele-specific amplification, result detection in real time and using TaqMan-probes complementary DNA polymorphic sites. The study of rs659366 polymorphism of the UCP2 gene has showed that 36.9% of patients had genotype AA, 46.7%--genotype AG, and 16.5%--genotype GG. The frequency of allele A was 60.2%, allele G--39.8%. BMI, value of fat mass, visceral fat area, serum glucose and triglyceride levels were significantly higher in carriers of A allele in the homozygous and heterozygous state than in carriers of G allele in the homozygous state. Frequency of A allele compared with G allele in obese patients (BMI greater than 30 kg/m2) was: OR--1.52; CI (1.24-1.86), p = 0.001, and in diabetes mellitus type 2--OR--1.22; CI (0.910-1.622), p = 0.19.

The rhinoviruses and coronaviruses are the most common causative agents of the acute upper respiratory tract infection in humans. They include several species that vary in the pathogenicity, some causing severe respiratory tract diseases. In this work, the species prevalence of rhinoviruses and coronaviruses was studied in 92 virus-positive clinical patients that were collected at the area of the Moscow region during the period from 2007 to 2012. Using the real-time PCR the virus circulation has been established for all species common in humans, including three rhinoviruses, HRV A, HRV B, and HRV C, and four coronaviruses, HCoV-NL63, HCoV-229E, HCoV-OC43, and HCoV-HKU1. For eight patients, the identity of the rhinoviruses, including 4 cases of HRV-C, 3 cases of HRV-A, and a single case of HRV-B, was corroborated using partial sequencing of the 5 non-coding regions and phylogenetic analysis. The viruses of HRV-C, HCoV-NL63, and HCoV-OC43 were prevalent in children with severe respiratory diseases.

For the period from 2003 to 2014 at the Oncogynecology Department laparoscopic surgery for ovarian cancer was performed in 49 patients aged 19 to 76 years. During the surgical interventions special attention was paid to the principles of oncological radicalism and ablastics, the volume of surgery depended on the extent of tumor process, morphological characteristics of tumor, a patient's age and the desire to preserve reproductive function. In 42 (85.7%) cases laparoscopic procedures were conducted to restaging (after non-radical operations in gynecological hospitals). In all 49 patients a histological form of ovarian tumor corresponded to adenocarcinoma. Mean operative time was 140 ± 10,5 minutes, the average blood loss--80,2 ± 14,3 ml. Postoperative complications (bleeding from the omentum) were recorded in 1 (2%) patient, the need for conversion was occurred in 4 (8.2%) cases due to the adhesive process or signs of dissemination. As a result of laparoscopic surgery an increase in staging of disease was fixed in 14 cases (28.6%). Follow-up median was 45 months, relapses occurred in 5 (10.2%) patients. Of 49 patients 2 (4.1%) died from disease progression. Disease-free and overall survival rates were 89.8% and 95.9%, respectively. Thus, data of world literature and our own experience indicate the potential equivalent of laparoscopic and laparotomy approaches in treatment for early ovarian cancer.

In the article there are considered the main problems of assessing public health risks of the combined effects of high temperatures and air pollution with the account taken of the consequences of abnormally hot weather observed in summer 2010 in Moscow and without equals in the history of meteorological measurements in the city. The daily average concentrations of fine suspended particles matter (PM10) in the city during peatland fires from 4 to 9 August are emphasized to be within the range of 431-906 μ/m3, being 7.2-15.1 times the Russian maximum permissible concentration (MPCs) (60 μ/m3). The anomalous heat and high levels of air pollution in this period were shown to cause a significant increase in excess mortality among the population of Moscow. There was established the relative gain in mortality from all natural causes per 10 μg/m3 increase in daily average concentrations of PM10 and ozone, which was respectively: 0.47% (95%; CI: 0.31-0.63) and 0.41% (95%; CI: 0.31-1.13). On the base of the statistical analysis of daily mortality rates, meteorological indices, the concentrations of PM10 and ozone there was developed marking scale for the risk assessment of these indices accordingly to 4 gradings--low (permissible), warning, alert, and a hazard level. There has been substantiated the importance of the introduction of the system for the early alert for hazard weather events and the unified rating scale for the hazard of high air temperatures and high levels of air pollution with PM10 and ozone, which allows to take timely measures for the protection of the public health.

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.

Aim: To estimate the prevalence of some modified cardiovascular risk factors (RFs) among the students of two Moscow higher education institutions to further test the technology of individual medical prevention counseling., Subjects and Methods: A questionnaire survey was conducted among 1912 first-year students (boys and girls, mean age 17.7 years) from 2 Moscow higher education institutions to reveal physical activity levels, smoking status, alcohol abuse, and food addictions., Results: Almost one third of the students (mainly girls) lead a sedentary lifestyle. The mean age at onset of smoking is 14.8 years. At the moment, the smoking students are 22% (28% of boys and 18% of girls). 12.2% of the respondents have moderate and high nicotine dependence. Most smokers demonstrate low motivation to give up smoking. The mean age for alcohol consumption is 15.8 years. 60% of the students use alcohol. There are no great differences in the drinking of alcoholic beverages between the girls and boys. 18% of the study sample students eat irregularly. Nearly 50% of the students add salt to cooked foods. 17% of the students eat too much sugar; more than 50% take sugar- and fat-laden foods. 54% of the students use vegetables and fruits insufficiently., Conclusion: Among all the modified cardiovascular RFs, alcohol use and irrational nutrition are most common among the students. Smoking and low physical activity are also relevant problems although these indicators among the students of Moscow are lower than among those in other regions of the Russian Federation. The found patterns call for the increased attention of the administrations of higher education institutions.

Background: Pseudomonas aeruginosa, the major nosocomial opportunistic pathogen, is an important cause of infectious morbidity and mortality among immunocompromised patients., Objective: To establish the role of metallo-β-lactamases (MBL) and efflux-mediated mechanisms in confer- ring carbapenem resistance in nosocomial isolates of P. aeruginosa., Methods: We analyzed carbapenem nonsusceptible nosocomial P. aeruginosa isolates obtained from pediatric and adult patients at three hospitals in Moscow in 2012-2015. Carbapenem susceptibility was assessed using the E-test. In addition, minimal inhibitory concentrations (MICs) of meropenem were tested by the broth microdilution method. The presence of MBL was determined using the ED TA-mediated suppression test. Efflux-dependent resistance was measured using an assay based on MIC modification by an ionophore carbonyl cyanide 3-chlorophenyl hydrazine (CCCP)., Results: A total of 54 carbapenem nonsusceptible P. aeruginosa isolates was examined. The presence of an MBL was detected in 37 (69%) isolates, 29 (54%) isolates had efflux-mediated resistance. In 10 (19%) isolates neither MBL nor efflux activity was found. Five out of 6 isolates (83%) with highly active efflux were MBL-positive. Among isolates with low efflux activity, 74% (17/23) possessed MBL, whereas in isolates with no efflux the rate of MBL-positivity was 60% (15/25)., Conclusion: The prevalence of MBL- and efflux-mediated carbapenem resistance in nosocomial P. aeruginosa is high. Moreover, our results reveal that several resistance mechanisms may combine at the isolate level. These data may contribute to the development of novel strategies in combating carbapenem resistance.

Objective: There is scarce information about the molecular epidemiology of HIV-infection in Armenia (former USSR). The objective of this work was to estimate the distribution of HIV-1 subtypes in this country and get any information about HIV drug resistance in naÏve patients., Design: A joint study involving 78 patients was carried out in Yerevan, Armenia and Moscow, Russia in 2009-2013. The cohort studies included mostly IDUs (28.2%) and heterosexuals (69.2%)., Results: The phylogenetic analyses based on population sequencing of partial pol gene found subtype A1 being the most prevalent (92.3%), followed by subtype B (3.9%). The HIV-1 tropism inferred from env V3-loop sequences was determined in 27 samples, among them R5-tropic viruses were found in 13 (48.1%) patients and X4- variants--in 14 (51.9%) patients. The prevalence of drug resistance in naïve patients was low (1.5%) with the only one mutation K219Q found., Conclusion: The composition and distribution of HIV-1 genetic variants in Armenia are evidently influenced by the Russian and other FSU countries epidemic, due to the significant volume of Armenian migrant/re-emigrant flows. Continued surveillance of HIV-1 circulating subtypes and drug resistance in Armenia is important for the proper management of HIV infection in this country.

Objective: Our aim was to compare results of the percutaneous coronary intervention (PCI) with drug elutingstent (DES) and bare metal stent (BMS) in older patients with coronary heart disease (CHD) and diabetes mellitus (DM) type 2., Methods: Patients (> 65 years) with DM type 2 were divided into two groups: the 1st group--58 patients after PCI with DES, the 2nd group--62 patients after PCI with BMS. The average follow-up period was 32.6 ± 8.0 months. The end-points of the study were death, non-fatal myocardial infarction and restenosis of the target stenosis., Results: Endovascular treatment of patients older than 65 years with DM is highly effective and safe despite the complexity of coronary lesions. There are no significant differences in the rate of early (hospital) complications in two groups. Also, we did notfind differences in three-year mortality between the groups. But the incidence of myocardial infarction in the groups with DES and BMS was 9% and 18% respectively (p = 0.039). Major adverse cardiovascular events (death, myocardial infarction and restenosis of the target stenosis) frequency was also lower in the group with DES compared to BMS (36% and 61% respectively, p = 0.001)., Conclusion: Endovascular treatment of patients older than 65 years with DM type 2 is a highly effective and safe method despite the complexity of coronary lesions. PCI with DES compared to BMS in older patients with DM is associated with improvement of medium-term results and decreases the number of cardiovascular events.

Evidence of the impact of air temperature and pressure on cardiovascular morbidity is still quite limited and controversial, and even less is known about the potential influence of geomagnetic activity. The objective of this study was to assess impacts of air temperature, barometric pressure and geomagnetic activity on hospitalizations with myocardial infarctions and brain strokes. We studied 2,833 myocardial infarctions and 1,096 brain strokes registered in two Moscow hospitals between 1992 and 2005. Daily event rates were linked with meteorological and geomagnetic conditions, using generalized linear model with controls for day of the week, seasonal and long-term trends. The number of myocardial infarctions decreased with temperature, displayed a U-shaped relationship with pressure and variations in pressure, and increased with geomagnetic activity. The number of strokes increased with temperature, daily temperature range and geomagnetic activity. Detrimental effects on strokes of low pressure and falling pressure were observed. Relative risks of infarctions and strokes during geomagnetic storms were 1.29 (95% CI 1.19-1.40) and 1.25 (1.10-1.42), respectively. The number of strokes doubled during cold spells. The influence of barometric pressure on hospitalizations was relatively greater than the influence of geomagnetic activity, and the influence of temperature was greater than the influence of pressure. Brain strokes were more sensitive to inclement weather than myocardial infarctions. This paper provides quantitative estimates of the expected increases in hospital admissions on the worst days and can help to develop preventive health plans for cardiovascular diseases.

The goal of this work was to analyze the antigenic structure of the hemagglutinin (HA) of the pandemic influenza virus A(H1N1)pdm09 using monoclonal antibodies (MAbs) and to develop a sandwich ELISA for identification of pandemic strains. Competitive ELISA demonstrated that 6 MAbs against HA of the pandemic influenza A/ IIV-Moscow/01/2009 (H1N1)pdm09 virus identified six epitopes. Binding of MAbs with 22 strains circulating in Russian Federation during 2009-2012 was analyzed in the hemagglutination-inhibition test (HI). The MAbs differed considerably in their ability to decrease the HI activity of these strains. MAb 5F7 identified all examined strains; MAbs 3A3 and 10G2 reacted with the majority of them. A highly sensitive sandwich ELISA was constructed based on these three MAbs that can differentiate the pandemic influenza strains from the seasonal influenza virus. The constancy of the HA epitope that reacts with MAb 5F7 provides its use for identification of the pandemic influenza strains in HI test. MAbs 3D9, 6A3 and 1E7 are directed against the variable HA epitopes, being sensitive to several amino acid changes in Sa, Sb, and Ca2 antigenic sites and in receptor binding site. These MAbs can be used to detect differences in HA structure and to study the antigenic drift of the pandemic influenza virus A(H1N1)pdm09.

In the article there are presented data of longitudinal study of the health of Moscow schoolchildren (426 children), followed throughout from the 1st to 9th class, inclusively. Students were annually clinically examined in the school. There was performed a comprehensive study of mental health and functional state of the organism in the process of education students in high school (over 2700 pupils of 5-9th classes). The health status of students was shown to deteriorate due to the increase of the prevalence of chronic disease, the rise in occupancy of the III-IV health groups, the decrease of the number of children referred to I and II health groups. Unfavorable trends in the health state among boys are more pronounced than in girls, while they are also characterized by lower functional capabilities of the CNS and lower resistance to the development of training fatigue. Relatively favorable stage of school ontogeny is characterized by period with reduced morbidity in children studying in 4th-6th classes. Deterioration in the health of students as a significant rate of the rise of chronic diseases morbidity is observed in 7-9th classes. Along with this, in the 7th and 9th classes there is revealed the deterioration of mental capacity and high frequency of the pronounced signs of fatigue among schoolchildren.

In high income countries females outlive men, although they generally report worse health, the so-called male-female health-survival paradox. Russia has one of the world's largest sex difference in life expectancy with a male disadvantage of more than 10 years. We compare components of the paradox between Denmark and Moscow by examining sex differences in mortality and several health measures. The Human Mortality Database and the Russian Fertility and Mortality Database were used to examine sex differences in all-cause death rates in Denmark, Russia, and Moscow in 2007-2008. Self-reported health data were obtained from the Study of Middle-Aged Danish Twins (n = 4,314), the Longitudinal Study of Aging Danish Twins (n = 4,731), and the study of Stress, Aging, and Health in Russia (n = 1,800). In both Moscow and Denmark there was a consistent female advantage at ages 55-89 years in survival and a male advantage in self-rated health, physical functioning, and depression symptomatology. Only on cognitive tests males performed similarly to or worse than women. Nevertheless, Muscovite males had more than twice higher mortality at ages 55-69 years compared to Muscovite women, almost double the ratio in Denmark. The present study showed that despite similar directions of sex differences in health and mortality in Moscow and Denmark, the male-female health-survival paradox is very pronounced in Moscow suggesting a stronger sex-specific disconnect between health indicators and mortality among middle-aged and young-old Muscovites.

Background: Pneumococcal infections remain a major medical problem associated with high morbidity and mortality. Moreover, the resistance of Streptococcus pneumoniae to conventional antibiotics is constantly growing. The implementation of pneumococcal conjugate vaccines (PCVs) in the last decade has dramatically reduced the incidence of the vaccine type-associated invasive pneumococcal diseases in many countries. However, information on the seroepidemiology of S. pneumoniae in Russia is limited., Methods: We report the results of serotyping and antibiotic susceptibility testing performed on 863 non-invasive pneumococcal isolates collected prospectively in 2009-2013 from children (median age 3.5 years) who sought medical care at five pediatric hospitals in Moscow. The isolates were recovered from the nasopharynx (71.2%), middle ear fluid (14.3%), and lower respiratory tract specimens (13.6%)., Results: In total, we identified 45 different serotypes. The six leading serotypes (prevalence >5%) included 19F (21.7%), 6B (12.8%), 23F (10.1%), 14 (9.0%), 6A (8.4%), and 3 (7.5%). Serotype 19A isolates had a prevalence of 2.3%. The proportion of PCV-13 serotypes was 78%; the coverage by PCV-7 was 58.2% and was similar to that of PCV-10 (59.8%). The rate of multidrug-resistant pneumococci (i.e., resistant to ≥3 antimicrobials) was 22%. The majority of the multidrug-resistant isolates were serotype 6B, 14, 19A, and 19F. Penicillin non-susceptibility was displayed by 28% of the isolates. The resistance rate to erythromycin was 26%. Among the examined erythromycin-resistant strains, 54% had the erm(B) gene and 13% had the mef gene as a single resistance determinant, whereas both determinants were found in 31% of these strains., Conclusions: Our data predict a good coverage of the circulating S. pneumoniae by the PCVs and could be useful for evaluating the serotype distribution in support of the introduction of PCV in Russia. In addition, the antimicrobial resistance rate of S. pneumoniae in Russia is substantial, and the emergence of pneumococcal strains with a dual macrolide resistance mechanism is alarming., (Copyright © 2013 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Unlabelled: Postoperative intracranial infectious complications are one of the most topical problems of neurosurgical intensive care due to theirs significant capability to impair outcomes of the main disease., Purpose of the Study: To define the risk factors of postoperative meningitis in patients with chiasm-sellar tumors., Research Objectives: 1. to define the effect of somatic and intracranial risk factors on occurrence of postoperative meningitis in patients after transsphenoidal and transcranial approaches to the tumor. 2. To define the effect of postoperative meningitis on outcomes of treatment in patients after transsphenoidal and transcranial approaches to the tumor., Materials and Methods: Somatic and intracranial risk factors of occurrence of postoperative meningitis (pneumonia, urinary tract infection, sepsis, intra-abdominal hypertension, the presence of external ventricular and lumbar drainage, monitoring of intracranial pressure, cerebrospinal fluid, and reoperation) were fixed every day. The study was conducted in the ICU of the Burdenko from October, 2010 to July, 2012. The 34 patients (19 males, 15 females) were included in the study (average age 47.5 years). The patients were divided into two groups; 17 patients each group. The group-1 included patients after transcranial approach to the tumor and the group-2 included patients after transsphenoidal approach., Results: In the group-1 a meningitis occurred in 3 patients (17.6% +/- 9.2%, DI [-0.4 - 35.6]). In the group-2 a meningitis occurred in 7 patients (41.2% +/- 11.9) DI 95% [17.8 - 64.4]. Accumulation of cerebrospinal fluid under the skin flap authentically increased a risk of a meningitis occurrence in patients after transcranial approach to the tumor (p = 0.031). There was no defined statistical significance of other risk factors. But there was defined a trend of the increasing of meningitis occurrence in patients after transsphenoidal approach in case of lumbar drainage or reoperation. Duration of mechanical ventilation and ICU stay in patients with meningitis was authentically longer than in patients without meningitis in both groups. In the group-2 the duration of mechanical ventilation and ICU stay was significantly shorter than in the group-1., Conclusions: Meningitis is not a typical complication of postoperative period in patients with transcranial approach to the tumor. After transsphenoidal approach a meningitis occurrence is likely in case of postoperative liquorrhea, lumbar drainage or reoperation. Subcutaneous accumulation of cerebrospinal fluid is a single defined statistically significant risk factor of meningitis. Postoperative meningitis impairs a condition of patients with chiasm-sellar tumors, increases the duration of mechanical ventilation and impairs treatment outcomes.

The article covers data on occupational morbidity in Moscow region over last 50 years. Stable number of newly diagnosed occupational diseases was seen up to first half of 1990s. Afterwards, steady decrease in occupational morbidity is seen with closure of major industrial enterprises. Among occupational pulmonary diseases, dust fibrosis (pneumoconiosis--44%) prevail. Tuberculosis complication of silicosis decreased, additional general somatic concomitants (arterial hypertension, ischemic heart disease, malignancies) are more frequent. Prevalence of occupational bronchial asthma has increased 16 times vs. that in 1976.

Surgery as being a preferential method of treatment of patients with cholangiocarcinoma is associated with high complications and mortality levels while demonstrating poor long-term outcomes. Optimization of preoperative management and improvement of the results of surgical treatment for patients with proximal extrahepatic bile duct carcinoma. From January 1998 to December 2013 surgical treatment was performed in 36 patients (19 males, 17 females) with Klatzkin's tumor, from whom 10 patients obtained postoperative chemotherapy. Bismuth-Corlette type III-IV tumor stage was determined in 30 (83.3%) patients. Portal vein resection was performed in 13 (36.1%) patients. 27 (75.5%) patients underwent R0 resection. Postoperative mortality rate consisted 16.7%, complications were revealed in 87.1% of cases. 6 (16.7%) patients required additional surgery and interventional procedures were performed in other 20 (55.5%) patients to fix postoperative complications. Overall 5-year survival rate in R0-resection group was 40.1%, median - 29 months. In postoperative chemotherapy group overall 3-year survival rate was 66.7% which was twice higher than in surgery group but the difference was not statistically significant (p=0.35). The improvement of short-term outcomes of surgical treatment for patients with Klatzkin's tumor requires optimization of preoperative management and detailed adherence of surgical techniques. Combination of surgery with postoperative chemotherapy showed the trend to improvement of overall survival.

Aim: To identify the meteorological factors or their combinations, which are most significant for the development of acute coronary syndrome (ACS) in different seasons., Subjects and Methods: A Statistica package was used to make an exploration analysis of the data of the A.S. Puchkov Central Emergency Medical Care Station on 63,412 admissions of patients diagnosed with acute myocardial infarction (AMI) to Moscow hospitals in 2009-2012 and those of the Hydrometeorology Center of Russia on weather conditions in the period under study., Results: Among the 63,412 patients, there were more men than women (p < 0.000005). Two long frost periods and three long abnormal heat periods were recorded in 2009-2012. In summer, the number of patients with a prehospital diagnosis of AMI was an average 19-22% less than in the other seasons. There was no peak in the number of hospitalizations during the abnormally hot summer of 2010. Air temperature proved to be a factor that was most strongly associated with the trend in AMI hospitalizations in men (MS = 1011.52, MSor = 27.27; p < 0.00005) and women (MS = 895.36, MSor = 25.37; p < 0.00005). The number of hospitalizations was negatively associated with daily average temperature in its positive range. In summer, the interdaily temperature difference turned out to be statistically significant; the highest number of hospitalizations was noted when it grew 6 °C colder. On days off, the number of admitted patients was 25% less than that on weekdays., Conclusion: The trend in hospitalizations for a referral diagnosis of AMI has a significant seasonal component. Their number was minimal in summer, including in the abnormally hot summer of 2010. Air temperature is the most important factor. Positive temperature was found to be strongly negatively correlated with diagnosed AMI hospitalizations.

The objective of the present study was to elucidate the causes of late detection of malignant neoplasms of ENT and oral cavity and low survival of the patents with these tumours in Moscow. The secondary objective was to elaborate the organizational measures for reducing the level of negligence and mortality from these malignancies among the city population. It was shown that the main cause behind the negligence is the late application of the patients for the medical assistance. Next in importance are asymptomatic clinical course of the disease in the absence of the pathognomonic and early signs of malignant neoplasms, a combination of several pathologies, imperfection of medical knowledge, and the poor resolving power of the modern methods. It is emphasized that the lack of vigilance against cancer among the practicing health providers is one of the main causes of medical errors. A few ways to address the problem of negligence with respect to malignant neoplasms of ENT and oral cavity in Moscow are proposed.

Background: Aim of the study was to estimate the possibility of prognosis incidence by means of degrees of cancer aggravated family history., Patients and Methods: 1233 families (n = 4689) from the Moscow Cancer Family Registry who answered 5-years later the first questionnaire were divided into 4 groups according to our classification of degrees of cancer aggravated family history: (1) not aggravated, (2) little aggravated, (3) aggravated, (4) syndromes (see detailed description in the text). The methods of genetic epidemiology, epidemiology, statistics were used., Results: Incidence in the first and second groups were near population expected cases, some higher in the aggravated group and sharp rise in women from the syndromes-associated families (the most syndromes predisposed to cancer of women reproductive system), relative risk was 10.76 for probands and 8.19 for the first relative women. There was no increase infrequency of new cases among men in syndrome-associated families., Conclusion: Analysis of degrees of cancer aggravated family history can be used for the incidence prognosis; one or two cancer cases among first degree relations don't regard as a high oncogenetic risk factor; members of families with syndromes are obligatory cancer risk group.

We included into this study 112 patients with ischemic heart disease (IHD) and concomitant type 2 diabetes mellitus (DM) subjected to percutaneous coronary interventions with stenting. Everolimus and sirolimus eluting stents (EES and SES) were implanted in 54 (group 1) and 58 (group 2) patients, respectively. After 12 months in groups 1 and 2 rates of repeat target lesion revascularizations (TLR) were 5.5 and 8.6% (odds ratio - OR - 0.62, 95% confidence interval - CI - 0.14- 2.74, p = 0.72); acute myocardial infarctions (MI) - 3.7 and 5.2% (OR 0.71, 95% CI 0.11- 4.4, p = 0.94); deaths - 1.85 and 1.7% (OR 1.1, 95% CI 0.1- 17.6, p = 1.0), respectively. There was no significant difference between groups by rate of unfavorable cardiac events (composite of cardiac death, nonfatal MI, and clinically indicated TLR) - 11.1 and 15.5% in groups 1 and 2, respectively (OR 0.68, 95% CI 0.225- 2.059, p = 0.69). Rates of stent thrombosis also did not differ (1.85 and 3.4% in groups 1 and 2, respectively; OR 0.53, 95% CI 0.05- 6.0; p = 0.94). Thus the use of EES and SES in patients with IHD and type-2 DM was equally effective.

Disability due to the loss of hearing is one of the main challenges to public health services and social protection of the population. The results of analysis performed by the author indicate the necessity of the comprehensive approach to the solution of disability problems for all social groups of the population. Special attention should be paid to the subpopulation of the able-bodied subjects with hearing disorders who need special medical and social rehabilitative measures to be developed and applied.

Aim: To characterize the 2013-2014 epidemic season from the results of detection of influenza infection in patients; to provide the molecular genetic characteristics of the strains isolated from deceased patients., Subjects and Methods: The investigators examined 1203 patients (387 children, 509 people older than 16 years of age, 307 pregnant women) admitted to Moscow Clinical Infectious Diseases Hospital One with the clinical signs of acute respiratory viral diseases. Nasal lavage and autopsy specimens were used to isolate viral strains, then to sequence genomic fragments, and to determine receptor specificity., Results: Out of the 1203 examinees, 284 (23.6%) were influenza-positive: 221 (77.8%), 24 (8.5%), and 39 (13.7%) patients had influenza A(H3N2), influenza A(H1N1)pdm09, and influenza B, respectively. Influenza was notified in 42,7% of the pregnant women. There was a preponderance of its moderate form; its severe form developed in single cases having comorbidities. One fatal outcome was registered. The intake of antiviral medications in the first 48 hours of the disease could prevent complications. The investigators revealed mutations in the strain isolated from the bronchoalveolar lavage fluid of a patient with severe pneumonia complicated by acute respiratory distress syndrome., Conclusion: There is evidence that there are mutant A(H1N1)pdm09 viruses that have high pneumotropicity. The high risk of their circulation in the population and the risk of severe influenza forms involving the lower respiratory tract remain. Early antiviral therapy in the first 36-48 hours diminishes the clinical manifestations of influenza and reduces the risk of developing complications.

Aim: To study the clinical features of pertussis in adults., Subjects and Methods: The clinical manifestations of pertussis in adults were analyzed in 62 patients treated in the Core Unit and Obstetric Unit, Clinical Infectious Diseases Hospital One, Moscow Healthcare Department, in 2011-2013., Results: Investigations conducted in the familial foci of pertussis showed that its incidence rate was 23.7 and 10% in adults and in pediatric institutions, respectively. The source of infant infection was adults in almost one third of cases, mothers in 72% and fathers in 27.7%. Assessment of the symptom complex of pertussis in the sick mothers in the observed period ascertained that 94±3% had experienced the typical form of whooping cough: 72.0±5.7 and 22.0±5.3% had its mild and moderate forms, respectively. The disease had run a latent course in 6±3% of the patients. The paper describes cases of pertussis in 5 pregnant women admitted to the obstetric unit for complaints of persistent cough. The diagnosis of whooping cough in all the cases was based on clinical and epidemiological findings and serological tests showing specific IgA and IgG antibodies. Three and two patients experienced moderate and mild pertussis, respectively., Conclusion: Pertussis now remains one of the infectious diseases relevant not only to a pediatric population, but also to an adult one. Adult pertussis maintains the main clinical features typical for this infection with a predominance of its mild forms, which makes its diagnosis difficult. A serological test (enzyme immunoassay) is of high diagnostic value for verifying whooping cough in adults under the present conditions.

Objective: To identify people at high risk of endogenous psychosis in patients of juvenile age with nonpsychotic mental disorders., Material and Methods: Authors examine 49 patients of juvenile age with symptoms of nonpsychotic mental disorders (ICD-10 diagnoses of mood disorder, personality disorder or schizotypal disorder)., Results: In all cases, symptoms related to signs of the premorbid stage of endogenous psychosis (schizophrenia and schizoaffective psychosis) were identified. After psychopharmacological treatment, an incomplete (<30%) reduction of psychopathological disorders recorded at admission was found in 24.5% of patients. Based on the response of patients to treatment, family history (having a first-degree relative with psychosis) and the diagnosis of mental disorder, it was singled out "high-risk" (20.4% patients) and "ultra-high risk" (18.4%) states for psychosis., Conclusion: In light of these findings, the necessity of a longitude prospective study of these patients and pharmacological interventions in outpatient conditions is discussed.

Occupation-related and physiologic studies in workers using personal computers revealed variable degrees of changed visual performance in accordance with work conditions class and integral parameter of work intensity. Findings are that the performance change is caused by lower accomodation volume and decrease in temporary characteristics of clear vision stability. Correlation was established between work conditions class and percentage of the performance decrease during the working shift in videodisplay users.

The results of the diagnosis and treatment of 117 patients with cervicothoracic injuries were analyzed. Different complications were observed in 51 (43.6%) cases. The main reasons contributing to the development of complications included late diagnosis of lesions of trachea and esophagus, acute blood loss, inadequate hemostasis during surgery.