[Organisation of medical care to military personnel with viral hepatitis. A during the local armed conflicts].

Organisation of medical care to military personnel with viral hepatitis A during the local armed conflicts. The article provides an analysis of medical care organisation system to patients with viral hepatitis A during conducting counterterror operations on the North Caucasus (1994-1996 and 1999-2002). The authors provided information on the main problems of medical support in modern local armed conflicts and shortcomings of organization of medical care to patients with viral hepatitis A in the following conditions: multistage, discrepancy between calculation of forces and facilities and character of military conditions, shortcoming of staff structure of medicalfacilities, inappropriate level ofproficiency ofphysicians of infectious profile and absence of regulations, concerning the use for equipment of infectious hospitals. 'Possible -ways for resolving these problems are showed.

[Meningococcal disease: early clinical diagnosis and emergency care].

Late diagnosis of meningococcal disease leads to high mortality. Early diagnosis of its generalized forms plays a crucial role in the pre-hospital phase and mainly based on the clinical picture of the disease. In most cases, pre-hospital typical mistake is late diagnosis of meningococcal disease: We propose an algorithm of early diagnosis of generalized forms of the disease in order to reduce the number of diagnostic errors. Proper and timely diagnosis will enable the physician pre-hospital fully implement measures to provide emergency and urgent care in generalized meningococcal infection, leading to. a more.favourable course and a significant improvement in the outcomes of the disease in the course of further hospital treatment.

[Reaferon in the treatment of hemorrhagic fever with the renal syndrome]. / Primenenie reaferona dlia lecheniia gemorragicheskoi likhoradki s pochechnym sindromom.

Ninety six patients with hemorrhagic fever and the renal syndrome were followed up. Reaferon was included into the complex therapy of 57 cases. The drug was administered intramuscularly in a dose of 2 x 10(6) IU twice a day for 5 days. The use of reaferon in the complex therapy resulted in a decrease in the period of the general intoxication by 3.4 +/- 1.3 days. The use of the drug at the initial stages prevented acute renal failure. When reaferon was used at the stage of oliguria, the level of proteinuria and the risk of the further affection of the kidneys lowered. After the completion of the treatment course with the use of reaferon, a significant increase in the content of the T-helper cells was observed which could be indicative of an activation of the mechanisms providing the immunity development and pathogen elimination. Reaferon promoted a decrease in the concentration of the circulating immune complexes of the blood serum. No significant adverse reactions to the use of reaferon were recorded. The results are in favour of the reaferon use in complex therapy of patients with hemorrhagic fever and the renal syndrome, especially at the initial stages until the syndrome of acute renal failure developed.

[HIV infection: the clinical and expert diagnostic aspects]. / VICh-infektsiia: nekotorye klinicheskie i ékspertno-diagnosticheskie aspekty.

PIP: In order to examine the character and phases of injury to the nervous system in HIV infection, 207 persons were observed. In 100, antibodies to the virus and to its separate proteins were discovered by immunofermentation analysis (IFA) reaction and by Western blot test. In 67, first phases of acute inflammation asymptomatic of persistent generalized lymphadenopathy were registered; and in 33, other ailments were found. In this group, which consisted of 74 men and 26 women aged 18-45, 91 were citizens of the Community of Independent States (15 of whom had served in the military) and 9 were citizens of other countries (4 had seen military duty). 75% of cases contracted the infection via sexual transmission. The control group comprised 65 seropositive people at the first screening confirmed by IFA but negative or doubtful by Western blot. Clinical laboratory and special psychological investigations were carried out using a 16-factor personality questionnaire and standard personality analysis methods. Generalized lymphadenopathy was found in 78%, hepatomegaly in 69%, chronic infection of the upper respiratory tract 67%, dermatological pathologies 33%, acute infections 32% (syphilis, hepatitis B), splenomegaly 20%, diarrhea and loss of more than 10% of body mass 11%. There was significant decrease of T-helper cells in 82.8%, in the correlation of the quality of T helper cells and T suppressor cells in 72.4%. In 67 persons who were in the second stage of HIV infection, there was a high frequency of pathological psychological symptoms. According to the personality scale, 60% had schizoid signs, 50% had depression, 40% had psychopathy, 30% had psychasthenia, and 20% had paranoia. When 33 persons in the second and third phase of the disease were measured, schizoid signs increased to 85.7%, depression to 78.6%, psychopathy to 57.1%, psychasthenia to 71.4%, and paranoia to 64.3%. In the first phases of the disease mainly hypochondria, depression, and hysteria predominated, and as the disease progressed, psychopathy, paranoia, psychasthenia, schizoid signs, and mania rose.^ieng

[The organization of dispensary observation for persons with a history of infectious diseases in Afghanistan]. / Organizatsiia dispansernogo nabliudeniia za litsami, perenesshimi infektsionnye zabolevaniia v Afganistane.

Outpatient control over the patients who went through infectious diseases in Afghanistan is determined by a structure of the dominant nosological forms of infectious diseases: typhoid, paratyphoid, intestinal amebiasis and other acute intestinal infections, viral hepatitis, malaria. A considerable number of servicemen who went through infectious diseases had led to a re-enforcement of "infections service" inside the organic structure of the 40th Army, as well as to elaboration of a rational system of outpatient control, including regular medical examinations by organic physicians, and infectionists, laboratory, functional and instrumental methods of examination by organic medical units and specialized health care establishments and sanitary-epidemiological units.

[The organization of medical care for patients with minor infectious pathology]. / Organizatsiia meditsinskoi pomoshchi legkobol'nym s infektsionnoi patologiei.

Taking into account the prognosticated modern character of combat actions, a new organic structure of Russian Armed Forces, and estimated structure of infectious diseases in war period, it was stressed that anti-infectious platoons (inside medical companies of Brigades) would perform the main part of diagnosis and treatment of minimally sick patients (85% from all infectious cases). There are proposals towards elaboration of a new organic structure of the military field infectious hospital.

[Solid-phase immunoenzyme analysis in the differential diagnosis of pulmonary tuberculosis and other infectious diseases with respiratory organ involvement]. / Tverdofaznyi immunofermentnyi analiz pri differentsial'noi diagnostike tuberkuleza legkikh i drugikh infektsionnykh boleznei s porazheniem organov dykhaniia.

The authors studied the information efficiency of stable-phased immunofermental analysis (IFA) in differential diagnosis of infectious diseases of respiratory system and pulmonary tuberculosis. IFA method was used on 60 infectious patients with non-tuberculous pathology, 64 patients with pulmonary tuberculosis and 200 donors. It was found out that the minimal diagnostical IFA titer in pulmonary tuberculosis was 1:320 (antibody revealing frequency--up to 89.2%; specificity--95%). IFA method with phosphatide antigen has a great practical significance in differential diagnosis of influenza, acute respiratory viral infections and pneumonias with pulmonary tuberculosis.

[The efficacy of enterosorption in bacterial intestinal infections]. / Effektivnost' énterosorbtsii pri bakterial'nykh kishechnykh infektsiiakh.

The article studies clinic manifestations after the prescription of polyphepanum, SKN-1P (based on recovered carbon) and enterodesum in 35 patients with acute dysentery, 104 patients with acute gastroenterocolitis, and 123 patients with typhoid. The first two drugs turned out to be highly effective for treatment of these infections. Enterosorption produced an insignificant positive effect in cases of typhoid. An early prescription of enterosorbents in enhanced doses could rapidly stop the basic proliferation of acute intestinal diseases. It is reasonable to start enterosorption even at the pre-hospital stage.

[The diagnostic and treatment characteristics of El Tor cholera and its combinations with other infectious diseases in an outbreak of multiple intestinal infection]. / Osobennosti diagnostiki i lecheniia kholery El'-Tor i ee sochetanii s drugimi infektsionnymi zabolevaniiami pri vspyshke kishechnoi poliinfektsii.

The article summarizes the experience of diagnosis and treatment of El Tor cholera in servicemen during an outbreak of intestinal polyinfection in the conditions of dry hot climate in desert and mountainous terrain of Afghanistan. The authors describe the clinical course of El Tor cholera which is stipulated by the mixed character of dehydration, polymorphism of clinical symptoms and more severe forms of concomitant infections.

[Characteristics of chemotherapy of infectious diseases associated with gunshot wounds and trauma]. / Osobennosti khimioterapii infektsionnykh zabolevanii v sochetanii s ognestrel'nymi raneniiami i travmami.

The experience in treating infectious diseases in wounded and traumatized persons from the contingent of the Soviet Troops in ++Afghanistan is described. The syndrome of the joint effect of the injury and infection is characterized. Features of the chemotherapy of the injured patients with viral hepatitis, malaria, typhoid fever and enteric and ++extra-enteric amebiasis under the ecological and professional stress and with an account of the etiology of the wound infection are presented. The favourable effect of the developed methods for chemotherapy of the joint affections was shown.

[Diagnostic and treatment experience with amebic lesions of the liver]. / Opyt diagnostiki i lecheniia amebnykh porazhenii pecheni.

The article studies the traits of diagnosis and treatment of 134 patients with amebic affections of liver. It is indicated that on the basis of clinical data it is possible to detect the development of amebic hepatitis or amebic abscess of liver. The most effective methods for treatment are: in case of amebic hepatitis--trans-umbilical injection of amebocytes; in case of amebic abscess of liver--percutaneous puncture of abscess under the ultrasonic sensor control, active aspiration of the content, cavity washing with antiamebic solutions and its trans-umbilical injections.

[The use of extracorporeal detoxication methods in treating infectious disease patients]. / Primenenie metodov ékstrakorporal'noi detoksikatsii pri lechenii infektsionnykh bol'nykh.

The article summarizes the results of 1090 operations of extracorporal detoxication (ED) performed on severe infectious patients. ED was realized by methods of hemosorption, plasmasorption, plasmapheresis for viral hepatitis, typhoid diseases and mixed infections. For each category of patients indications and counterindications for ED application were worked out. Positive results were marked at 54-92% of cases, depending on nosological forms, period of illness and ED type. The authors propose a scheme of indications, optimal parameters and criteria for ED efficiency estimation. ED methods adopted for Afghan conditions can be successfully used in other regions with dry and hot climate.

[Viral hepatitis A and the possible pathogenetic mechanisms of a protracted convalescence]. / Virusnyi gepatit A i vozmozhnye patogeneticheskie mekhanizmy zatianuvsheisia rekonvalestsentsii.

Metabolites of connective tissue (free serum oxyproline, protein-bound plasma oxyproline, total urine oxyproline, serum glycosaminoglycans), proteolytic enzyme elastase, proteolysis inhibitors (alpha 1-inhibitor, alpha 2-macroglobulin) were investigated in 103 patients with viral hepatitis A. It was established that connective tissue and its metabolites produce a negative effect on hepatocytic repair. Longterm convalescence is attributed to elastase hyperactivity in the presence of relative deficiency of proteolytic inhibitors.

[Hyperbaric oxygenation in the combined therapy of infectious diseases]. / Giperbaricheskaia oksigenatsiia v kompleksnoi terapii infektsionnykh boleznei.

Hypoxia plays an important role in pathogenesis of infectious diseases. Therefore, its correction is an essential factor in pathogenetic antibacterial treatment. Hyperbaric oxygenation (HBO) as a leading method in current antihypoxic therapy was studied in combined medication for typhoid, diphtheria, meningococcal infection, viral hepatitis. HBO sessions were given to 331 patients, 363 controls did not receive HBO. Utilization of HBO provided much better saturation of blood with oxygen, eliminated metabolic disorders, warranted favorable course and outcomes of the diseases.