Vol 34, No 4 (2017)

Cover Page
Articles
EPIDEMIOLOGIC PECULIARITIES OF TICK-BORNE VIRAL ENCEPHALITIS IN CHILDREN
Okuneva I.A.
Abstract
Aim. To estimate the manifestations of epidemic process of tick-borne viral encephalitis in children and detect some factors, determining morbidity. Materials and methods. Manifestations of epidemic process of tick-borne viral encephalitis in children and social risk factors for 32 years were analyzed using official statistics of “Centre of Hygiene and Epidemiology in Perm Krai” (forms №1, 2, 5 and 27). Results. Tick-borne viral encephalitis sickness rate in children exceeded the adult’s morbidity ( p < 0,05). Risk groups included unorganized children aged 3-6 years with morbidity index equal to 36,6 ± 9,2 per 100 thousand of the population and schoolchildren with this index 26,1 ± 2,9 per 100 thousand of the population ( p > 0,05). The share of patients with moderate and severe clinical course in children was 92,4 ± 2,5% versus 71,6 ± 1,3% in adults ( p < 0,05). Cyclic recurrence and seasonality of morbidity among children was more marked, as compared with the adults. Conclusions. Peculiarities of manifestations of epidemic process in children with tick-borne viral encephalitis are determined by differences in conditions they were infected and wider involvement into prophylactic immunization.
Perm Medical Journal. 2017;34(4):5-9
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THEORETICAL CONCEPTION OF EPIDEMIOLOGY OF HEALTH CARE-ASSOCIATED INFECTIONS
Kuzin A.A., Svistunov S.A., Zharkov D.A., Belov A.B.
Abstract
Aim. To study the causes as well as mechanisms of occurring and prevalence of infectious complications among patients of a surgical hospital. Materials and methods. Scientific literature (440 sources) on the problem of health care-associated infections (HCAI) at a specialized surgical hospital for treatment of severe wounds and injuries, annual reports of a surgical hospital during 2002-2011 were studied; retrospective study of the results of treatment of 18139 patients with infectious complications for 1999-2011 was fulfilled. Results. The results of the study of cause-and-effect relations of infectious complications at a surgical hospital as well as theoretical conceptions of clinicoepidemiological manifestations of health care-associated infections are presented. The principles of prevention, which are to be used in practical activity of medical specialists, who carry out measures for prevention of infectious complications among patients and their treatment in case of their development, are emphasized. Conclusions. When preserving the principle of complexity of preventive and anti-epidemiological measures, it is necessary to single out the basic measure in each separate case. The choice of the main measure depends on concrete peculiarities of patients contingent and organization of treatment and diagnostic process.
Perm Medical Journal. 2017;34(4):10-17
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PEDIATRIC SURGERY RISK-ORIENTED APPROACH IN PREVENTION OF INFECTIONS IN THE REGION OF SURGICAL INTERVENTION
Malashenko A.A.
Abstract
Aim. To assess the risk factors for the development of IRSI among patients of children’s surgical units. One of the leading forms of health care-associated infections, developing in the postoperative period, including pediatric surgery, is infections in the region of surgical intervention (IRSI). In spite of multiple studies on the assessment of IRSI risk factors in the adult population, their significance among children remains insufficiently explored. Materials and methods. The data of surgical outcomes for 2015, including analysis of surgical protocols, analysis of cards of data collection for IRSI detecting, analysis of cards of active epidemiological observation of surgical outcomes were retrospectively analyzed. To reveal patient’s infection, standard determination of IRSI case, developed by The Center for Control and Prevention of Diseases (CDC, USA) was used. Influence of external and internal factors on the development of IRSI in pediatric surgery was estimated. Results. It was revealed while studying that IRSI frequency among patients of pediatric surgery units was 13,6 per 100 operative interventions. This index is significantly higher than the data of official registration and proves the necessity of introducing qualitative epidemiological observation in respect of IRSI at such units and use effective measures for their prevention. The most frequently complicated surgeries were those on the gastrointestinal tract, airways, appendectomy. Conclusions. The results of this study demonstrate that IRSI frequency significantly depends on the availability of concomitant diseases, ASA index, surgical wound class, risk index NNIS.
Perm Medical Journal. 2017;34(4):18-23
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RISK FACTORS FOR DEVELOPMENT OF HEALTH CARE-ASSOCIATED INFECTIONS IN PATIENTS OF ONCOGEMATOLOGY AND BONE MARROW TRANSPLANTATION UNITS
Ryakhovskikh S.A., Lyubimova A.V.
Abstract
Aim. To reveal the risk factors for the development of health care-associated infections (HCAI) in oncohematological units. One of the main problems of failure of treatment among oncohematological patients are infectious complications, first of all, associated with medical care. Materials and methods. The study “case-control” was carried out on the bases of three units of bone marrow transplantation and Research Institute of Pediatric Oncology, Hematology and Transplantation named after R.M. Gorbacheva. The study involved 102 patients, treated over the period from 01.12.14 to 30.11.15. The group “cases” included patients with HCAI. Health care-associated infections were detected using standard determination of a case for each of nosological forms; the group “control” - patients without HCAI, treated at the studied units during the same period. Each group joined 51 patients. Results. The common risk factors for all the considered types of infectious complications were duration of neutropenic fever for more than 3 days, polychemotherapeutic scheme “fludarabine+busulfan”, all schemes of polychemotherapy, including fludarabine. The greatest number of risk factors was detected for such severe and nosological HCAI forms as sepsis and pneumonia. Fludarabine is an independent risk factor for the development of HCAI, its influence is growing against the background of presence of another risk factors, such as neutropenic fever. Conclusions. Until now, fludarabine, as a factor, causing the development of severe forms of infectious complications was described only for patients with chronic lymphatic leukemia. It was revealed that this chemical is an independent risk factor for patients with acute leucosis as well.
Perm Medical Journal. 2017;34(4):24-32
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STREPTOCOCCUS MUTANS - POSSIBLE RISK FACTOR FOR ANTIBIOTIC RESISTANCE PREVALENCE
Brodina T.V., Lyubimova A.V., Feting A.E., Silin A.V., Yusupova R.F., Kiselev A.V., Klimova E.A.
Abstract
Aim. To assess the prevalence of erythromycin and tetracycline-resistant S.mutans strains, isolated from child dental deposit; to determine the leading mechanism of their resistance to microlides. Materials and methods. Eighty six S. mutans strains, isolated from the dental deposits of children aged 6-17 years were studied. Screening of erythromycin resistance was fulfilled with two methods - phenotypical and genotypical, tetracycline - with phenotypical alone. Results. The share of S. mutans isolates, phenotypically resistant to erythromycin, was 16 % , to tetracycline - 26,7 %. The prevailing molecular-genetic mechanism of erythromycin resistance - presence of mef A-gene (78,6 % of all erythromycin-resistant strains); 10,5 % of all the studied S. mutans strains is a potential reservoir of antibiotic resistance genes ( erm B and mef A) in the horizontal transmission.
Perm Medical Journal. 2017;34(4):33-37
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ASSESSMENT OF POTENTIAL ROLE OF PATIENTS WITH ASSOCIATED HIV-INFECTION AND TUBERCULOSIS AS A SOURCE OF TUBERCULOUS INFECTION
Sergevnin V.I., Sarmometov E.V., Zimina V.N., Mikova O.E., Varetskaya T.A.
Abstract
Aim. To estimate the potential role of patients with associated HIV infection and tuberculosis as a source of tuberculous infection as compared with monotuberculosis patients. Materials and methods. Epidemiological danger of patients was assessed by the degree of bacterioexcretion massiveness and its share in the structure of M. tuberculosis of virulent genotype Beijing. Massiveness of bacterioexcretion was studied by the results of luminescent microscopy and bacteriological analysis of phlegm, genotyping - with test-system “Amplitub-Beijing” and method MIRU-VNTR. Results. It was established that in spite of the lesser quantity of M.tuberculosis, excreted by patients with HIV-infection associated with tuberculosis, as compared to patients with monotuberculosis, coinfected patients more often discharge high-virulent genotype Beijing, therefore, may be more epidemiologically dangerous as a source of tuberculous infection. Conclusions. According to the results of bacteriological study of the phlegm by means of dense nutrient medium, in patients with associated HIV infection and tuberculosis lesser massiveness of M. tuberculosis excretion than in patients with tuberculosis without HIV infection was revealed. In the structure of M. tuberculosis, isolated from patients with associated HIV-infection and tuberculosis, the share of genotype Beijing was more than 90 %, from patients with tuberculosis without HIV-infection - only 70 %.
Perm Medical Journal. 2017;34(4):38-44
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PREVALENCE AND HYGIENIC CHARACTERISTIC OF HEPATITIS C VIRUSES ON THE TERRITORY OF VORONEZH REGION
Chemodurova Y.V., Mamchik N.P., Sitnik T.N., Mukha T.A., Bezdvernaya N.A.
Abstract
Aim. To analyze the prevalence of acute and chronic forms of hepatitis C, and characterize the structure of viral hepatitis C (VHC) genotype in Voronezh region for further improvement of epidemiological supervision of infection and estimation of possibilities for antiviral therapy. Materials and methods. Hepatitis C sickness rate among the population of Voronezh region over the period of 2000-2016 was studied. The results of studying blood serum samples for genetic typing of 5504 dispensary patients, which were obtained from adults during 2013-2017, are presented in the paper. Viral hepatitis C genotypes were determined using the test-system “AmpliSens HCV-1/2/3” (Central Scientific Research Institute of Epidemiology of the Ministry of Healthcare of the Russian Federation). Results. In the dynamics of acute hepatitis C (AHC) sickness rate up to 2012, annual reduction of indices was noted, however, in 2013-2016 there was detected a two fold growth of morbidity, exceeding mean values in Russia. During the last 5 years, sickness rate of the population with chronic form of hepatitis C on the territory of Voronezh region was lower than in the country as a whole by 2 times and more. On the territory of Voronezh region, a great variety of circulating genotypes of hepatitis C virus including 1a, 1b, 2, 3, 4 was detected. In the population of patients there prevail genotypes 1b (46,7 %) and 3 ( 45,0 %). Conclusions. As a whole, the present situation reflects the landscape of this infection, existing in the European part of Russia.
Perm Medical Journal. 2017;34(4):45-53
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EPIDEMIOLOGICAL ASSESSMENT OF RISK FACTORS FOR PREVALENCE OF ANTIBIOTIC-RESISTANT STRAINS OF UPPER AIRWAYS AND ENT-ORGANS INFECTIOUS PATHOGENS IN CHILDREN
Shishmakov A.A., Kolesnik D.S., Toleuova Z.G., Kolodzhieva V.V., Lebedeva E.A., Goncharov A.E., Zueva L.P., Nacharov P.V., Verbolova S.V., Dveirina I.A., Makhotina L.P.
Abstract
Aim. To give epidemiological assessment of potential risk factors for prevalence of antibiotic resistant strains of upper airways and ENT-organs infectious pathogens in children. Materials and methods. The study included children (165 persons) aged 1 to 17years, who asked for ambulatory-polyclinic medical care in connection with upper airways and ENT-organs diseases and formed the group of “cases” (75 persons) - patients, colonized by Streptococcus spp. and Staphylococcus aureus strains with antibiotic resistance not less than one of three classes (beta-lactams, macrolides, lincosamides) and the control group (90 persons) - patients without the facts of colonization by antibiotic-resistant strains of the studied microorganisms. During doctor’s reception, parents of all patients were surveyed. Results. According to the results of a survey carried out, there was estimated connection of 18 potential risk factors with carriage of antibiotic-resistant strains. Pneumococcal vaccination in the investigated population was a factor, rendering preventive effect on the colonization rate of antibiotic-resistant strains Streptococcus spp. and Staphylococcus aureus ( OR = 0,40 [95 %DI 0,19-0,86]). At the same time, no ties between colonization by antibiotic-resistant microorganisms and risk factors, connected with previous use of antibiotics, especially without doctor’s administration, was noted. Conclusions. Vaccination with pneumococcal vaccines in the studied population is a factor, controlling prevalence of resistance to antimicrobial drugs
Perm Medical Journal. 2017;34(4):54-59
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PHENOTYPICAL AND MOLECULAR-GENETIC MONITORING OF NEISSERIA GONORRHOEAE, CIRCULATING IN WESTERN URAL
Rumyantseva M.A., Kolomoitsev A.V., Karpunina T.I., Elkin V.D.
Abstract
Aim. To study the biological peculiarities of N.gonorrhoeae strains, isolated from patients of Perm Krai. Materials and methods. Gonococcal infection sickness rate for 2010-2015 in Perm Krai was analyzed using intensive indices. Sixty clinical N.gonorrhoeae strains were used in this work. Primary identification of cultures was carried out at Regional Venereologic Dispensary using bacterioscopic and bacteriological methods with standard surgical procedures. To confirm the species belonging of isolated cultures, PCR method in real-time mode was applied. Results. An approximate value of the average annual increase was 5,85 %. It was shown that use of molecular-genetic analysis essentially adds to phenotypical monitoring of N.gonorrhoeae that permits to assess genetic variety and mechanisms of resistance to antibacterial agents of the strains, circulating throughout the administrative territory. Conclusions. The first experience of such studies showed genetic variety of N.gonorrhoeae , circulating in Perm Krai, and revealed a number of peculiarities of gene prevalence, determining their sensibility/resistance to antimicrobial drugs.
Perm Medical Journal. 2017;34(4):60-66
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EPIDEMIC PROCESS OF MEASLES INFECTION DURING ITS ELIMINATION PERIOD AND STRATEGIC DIRECTIONS OF CONTROL IN REAL TIME CONDITIONS
Golubkova A.A., Platonova T.A., Kharitonov A.N., Sergeev A.G., Lelenkova E.V., Yuzhanina T.S.
Abstract
Aim. To determine the strategic directions for control of infection in the structure of supervision and control system in conditions of megapolis. In spite of significant success in fight against measles, this infection still remains dangerous for the population. Materials and methods. The data of official registration of measles sickness rate among Ekaterinburg population for 1988-2016 and the results of serological investigation of different groups of the population for anti-measles IgG were used as study materials. The population engaged into the study: industrial workers (118), medical staff (369), staff and students of medical higher school (258). Epidemiological, serological and statistical methods of study were used. Results. For the studied period, epidemic process of measles infection on the territory of Ekaterinburg was intermittent. Against the background of sickness rate fall there were registered local ictuses. A share of persons with seroprotection in different age and professional groups was established to be from 63% to 83%; the greatest part of persons with protective level was observed at the age over fifty. It was detected that 10 and more years after the last vaccination, 30-40% of the examined patients are deprived of protective level of antibodies. Conclusions. To control the epidemic situation for measles, it is necessary to cover with measles immunization not less than 95-98 % of children in indicator groups and not less than 85 % of all the population; the age for measles immunization should be prolonged among adults to 55 years (among all groups of the population) with revaccination every 10 years.
Perm Medical Journal. 2017;34(4):67-73
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METHODICAL APPROACHES TO ORGANIZATION OF AMBULATORY UROLOGICAL INSTITUTION MODEL BY PRINCIPLES OF MUNICIPAL-PRIVATE PARTNERSHIP
Gevorkyan A.R.
Abstract
Aim. To determine the methodical approaches to formation of modern functional-organizational model of urological ambulatory institution on the principles of state-private partnership. Actuality of this study is conditioned by the necessity of attracting private investments to the sphere of municipal healthcare, so as to improve the system of ambulatory urological aid. Materials and methods. So as to reach the posed problem, the general scientific methods of analysis, synthesis, generalization, interpretation of scientific data as well as systemic and structural-functional approaches were used. Results. Scientifically grounded methodology of restructuring of the system of ambulatory urology as a set of approaches to the development of municipal system of ambulatory urological aid on the principles of state-private partnership is presented in the paper. There are presented methodical approaches to the development of the model of ambulatory urological institution with mechanisms of mixed economy, which develops relations between business and municipality, involves resources of private investor in process of reproduction and elevates efficiency of work of ambulatory urological system. Conclusions. The above methodology of restructuring of the system of municipal ambulatory urological care is an aggregate of approaches to its adaptation to the requirements of municipal-state partnership.
Perm Medical Journal. 2017;34(4):74-81
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ESTIMATION OF MEDICAL WORKERS’ INFORMATION LEVEL ON PROBLEMS OF UNDESIRABLE POSTVACCINAL PHENOMENA
Lopushov D.V., Trifonov V.A., Sabaeva F.N., Fazulzyanova I.M., Shaikhrazieva N.D.
Abstract
Aim. To estimate the level of medical staff knowledge on the problems of undesirable postvaccinal phenomena and their attitude to vaccinal prevention. Materials and methods. The results of survey regarding the knowledge of medical workers on the problems of registration, investigation of undesirable postvaccinal reactions are presented in the paper. Results. It was detected while carrying out questionnaire design that a significant part of medical workers faced undesirable postvaccinal phenomena in their practice, however, less than a half of them had specialized training on vaccinal prevention; it can negatively influence the quality of rendering medical care in case of undesirable phenomena in the postvaccinal period. The effect of factors, promoting the development of undesirable phenomena in the postvaccinal period, was analyzed. Conclusions. The conducted study demonstrated the necessity of specialized training of medical staff of all specialties on vaccinal prevention. The questions of undesirable phenomena in the postvaccinal period should be considered while training.
Perm Medical Journal. 2017;34(4):82-88
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TRAINING OF EPIDEMIOLOGIST IN CONDITIONS OF PRESENT-DAY EDUCATIONAL STANDARDS AND QUALITY MONITORING
Golubkova A.A., Fedorova E.V., Smirnova S.S.
Abstract
Aim. To evaluate the employers’ satisfaction with the level of training of epidemiologists. Materials and methods. The staff of the Chair of Epidemiology of Ural State Medical University worked out a questionnaire and carried out a survey, permitting to evaluate the correspondence of a graduating student to professional standard, ability to independent activity, attitude to functional duties. All heads of territorial departments of Rospotrebnadzor Board in Sverdlovsk region, branches of “The Centre of Hygiene and Epidemiology in Sverdlovsk region”, head physicians of medical institutions, where graduates practiced, took part in the survey. The level of theoretical knowledge and practical skills, obtained while training at the university, employer’s satisfaction and readiness to give employment, or to recommend these students to other heads of organizations were also estimated. Results. The employers’ opinion on the quality of training of graduating students of Medical and Prophylaxis Faculty of the Chair of Epidemiology was analyzed. Quality management in the sphere of epidemiologists’ training in conditions of up-to-date educational standards was actualized. Conclusions. A constant dialogue between the body of educational institution and the employers and analysis of their opinion regarding the quality of graduates’ level of knowledge contributes to revealing and elimination of drawbacks in specialists’ training, growth of the quality of educational services in present-day conditions.
Perm Medical Journal. 2017;34(4):89-93
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HEALTH CARE-ASSOCIATED SAPRONOUS INFECTIONS: PROBLEMATIC QUESTIONS OF EPIDEMIOLOGICAL THEORY
Belov A.B., Kuzin A.A.
Abstract
The content of epidemiological terminology used in relation to health care-associated sapronous infections from the ecological positions is discussed in the review. There was noted a discrepancy to this content in respect of the biological essence of symbiotic relations of sapronous bacteria and the biological hosts in nature. The necessity of unified notion of the reservoir role of hosts’ lower organisms in circulation of sapronous bacteria in the composition of symbiotic systems, irrespective of symbiots “abiotic” medium, is grounded. In relations between bacteria populations and hosts, environmental conditions have regulating functions and provide circulation of pathogens along the trophic paths, used by symbiots. The content of epidemiological terminology and structure of classification of infections and their pathogens, applied for health care-associated sapronous infections, should correspond to ecological and philosophic interpretation of biotic reservoirs of sapronous bacteria.
Perm Medical Journal. 2017;34(4):94-102
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