[Clinicoepidemiological features of echinococcosis in men serving in the navy].

AIM: To analyse echinococcosis morbidity and course characteristics in men serving in the Navy. MATERIAL AND METHODS: The results of annual 1983-2006 check-up of Navy men were analysed to estimate echinococcosis morbidity in patients with eosinophilia and tumors including cysts. The diagnosis was made with application of clinical, ultrasound, radionuclide, morphological (including parasitological), biochemical and immunological methods, computed tomography. RESULTS: 14 cases of hydatid echinococcosis were documented. Most of the patients (85.7%) were young (18-22 years of age). The patients were infected before the army in highly endemic regions. Solitary echinococcosis was detected in 8 patients. In multiple echinococcosis 1 patient had 4 cysts, 3 patients--3, 2 patients had 2 cysts. Echinococcosis of stage 1 was diagnosed in 3 patients, stage 2--in 11 patients. All the patients had cysts in the liver. In multiple echinococcosis the cysts occurred more often in the liver, spleen, kidney; they were rare in the lungs, bones, brain. Pain, asthenovegetative, dyspeptic and allergic syndromes were registered in 71.4, 28.6, 14.3 and 7.1 cases, respectively. Eosinophilia was encountered in 42.9% cases. These syndromes were, as a rule, weakly pronounced. Before accurate diagnosis 6 patients for 4-10 months were treated outpatiently for chronic gastroduodenitis, recurrent lumbalgia, biliary dyskinesia and intercostal neuralgia. CONCLUSION: Echinococcosis incidence rate in the Navy men is very low. They are infected before the army. The disease is diagnosed by chance or late, manifests primarily with pain symptoms.

[Echinococcosis in servicemen: epidemiology, clinical picture, treatment and military medical examination].

On the basis of our own and literary data the epidemiology, pathogenesis, clinical picture, diagnostics, treatment, military medical examination and regular medical check-up of the patients with echinococcosis were developed. The detailed clinical and anatomic classification of the disease is given for the first time. The characteristic clinical case of multiple echinococcosis, the special features of its diagnosis and treatment are described.

[Symptoms of diphyllobothriasis in young males serving in the army].

AIM: To study prevalence and clinical symptoms of diphyllobothriasis in military personnel. MATERIAL AND METHODS: Non-random sample of 123 patients was examined, 72 healthy military personnel entered a control group. Total blood count, urine analysis, chest fluorography, coproovoscopic tests, test for occult blood, fibrogastroduodenoscopy, blood biochemical tests, ECG were conducted. By hemoglobinemia the patients were divided into three groups: hemoglobinemia (group 1), 120-130 g/l (group 2), under 120 g/l (group 3). RESULTS: Most patients of groups 1 and 2 felt healthy. Fragments of helminths at defecation were detected in 3.9%. Dispeptic complaints, abdominal pain occurred in 13% patients of groups 1 and 2, asthenovegetative symptoms - in 9%. Patients of group 3 had complaints directly correlating with anemia severity. Eosinophylia was weak in all the groups. Signs of gastritis were revealed by gastroscopy in 13% patients, achylia was absent. CONCLUSION: Diphyllobothriasis in military personnel ran a mild course. 72% cases were asymptomatic. Clinical manifestations of invasion were related to anemia. Severe anemia and complications of invasion developed acutely in 4% patients who had long-term invasion, intensive physical loads and severe concomitant diseases.

[Anthropurgic foci of pseudotuberculosis and the mechanisms of their formation in groups of servicemen].

At the period of 1982 - 2003, morbidity rate in pseudotuberculosis and the Yersinia pseudotuberculosis culture rates in groups of servicemen (from different abiotic objects, from humans and small rodents) in different geographic zones were studied. The cases of the isolation of Y. pseudotuberculosis were most frequently registered in groups of servicemen in the Far East and the Kola Peninsula. In these regions the highest morbidity rate in pseudotuberculosis was registered among servicemen. The contamination rate of vegetables during the year was always greater than in other objects under study, including small rodents. The study demonstrated that in the Armed Forces could appear, temporary and relatively constant anthropurgic foci of pseudotuberculosis even in non endemic regions. They were formed in the objects of the food supply service due to the supply of contaminated vegetables. Synanthropic rodents played a secondary role, though they too facilitated the formation of new anthropurgic foci. Under definite conditions anthropurgic foci could exist autonomously, independently of natural foci.

[The meningococcal infection on Navy: modern clinical-and-epidemiological aspects]. / Meningokokkovaia infektsiia v voenno-morskom flote sovremennye kliniko-épidemiologicheskie aspekty.

The article presents the own data about modern clinical-and-epidemiological peculiarities of a meningococcal infection on Navy for 20 consecutive years (1982-2002) based on the analysis of the annual reports of fleet medical services and the inspection of 275 centers of a meningococcal infection in military troops. The centers with the single generalized form of a meningococcal infection prevailed. The centers with the number of people from 10 to 40 men amounted to 82%. The frequency of the meningococcal defeat of the people in the centers varied from 25% to 37% with the main role of meningococcae A. In the structure of a meningococcal infection the generalized forms amounted to 16%, located forms--25%, carriers--59%. In all regions the major form of the display of epidemic process in military collectives was seasonal sick rate. The article proved the electoral approach to the character and volume of curative-and-preventive measures.

[Characterization of the foci of meningococcal infection in closed groups of males]. / Kharakteristika ochagov meningokokkovoi infektsii v muzhskikh kollektivakh zakrytogo tipa.

A total of 257 foci of meningococcal infection in groups of servicemen were selectively examined in 1982-2002. From these groups 353 patients with generalized forms of the disease underwent hospitalization. Most of the foci had a single infection, the proportion of foci with 10-40 patients was 82.6%. The meningococcal infection rate among humans in the foci was 25-37%, group A meningococci playing the leading role. In the structure of meningococcal infection generalized forms of infection constituted 16%, localized forms constituted 25% and inapparent forms (carriers)--59%. The formation of the morbidity structure was influenced by the type of the focus (with a single or multiple infection) and the character of morbidity for many years (during epidemic or at the period between epidemics). No absolute dependence of the level of meningococcal carrier state in the groups of servicemen on the appearance of the generalized forms of meningococcal infection was noted. Thus, both during epidemic and at the period between epidemics the population of meningococci, heterogeneous in its serological structure and differing in its clinical and epidemiological importance, constantly circulated with the leading role played by group A meningococci.

[Problems of etiotropic therapy of typhoid fever and approaches to their solution]. / Problemy étiotropnoi terapii briushnogo tifa i puti ikh resheniia.

The main problems of etiotropic therapy for typhoid fever lie in underestimate of the characteristic features of its pathogenesis and particularly in development of typhoid granulomas and their histogenesis, as well as in wide spread of typhoid fever pathogenic strains resistant to the routine chemotherapeutics, i.e. polyresistant strains. Some problems are due to incorrect choice of the antimicrobials and their combinations, optimal doses, administration routes and pathogenetic therapy. In the XXth centure an increase in the emergence and a change in the nature of the typhoid fever pathogen resistance to antimicrobials were observed. It was shown that from the pharmacologic and pharmacodynamic viewpoints the highest efficacy of typhoid fever therapy should be provided by the following antimicrobials: fluoroquinolones (except for norfloxacin), 3rd and 4th generation cephalosporins, aminopenicillins, chloramhenicol (levomycetin), combinations of 2nd and 3rd generation aminoglycosides with biseptol, aminopenicillins or doxycycline, as well as chloramphenicol combinations with aminopenicillins or 2nd to 4th generation cephalosporins. Practical recommendations for the etiotropic therapy of patients with typhoid fever during its outbreak or epidemic are presented.

[The specific features of malaria clinical course debut in servicemen arrived in tropics from non-malariogenic regions]. / Osobennosti nachala klinicheskogo techeniia maliarii u voennosluzhashchikh, pribyvshikh iz nemaliariogennykh regionov.

The specific features of initial period of vivax and tropical malaria were defined with the help of clinical-and-laboratory methods in two groups of servicemen (70 persons in each group) differed by the period of stay in tropics. For comparison 30 similar patients, the tropics inhabitants, were investigated. In local inhabitants the course of all forms of malaria was rather mild with development of disease characteristic paroxysms in most of them. The reverse correlation of disease severity and period of servicemen' stay in tropics was revealed. For both forms of malaria the migrants compared with local inhabitants had the prodromal period and initial fever without typical paroxysms. The following debuts of malaria were revealed in servicemen: the frequent (influenza-like, arthralgia-like, gastrointestinal, bronchopneumonic, typhoid-like) and the rare (abdominal and painful, cerebral: meningeal and comatose, dysentery-like, tuberculosis-like, hemorrhagic). The shown features of malaria initial period in servicemen caused difficulties in its early diagnosis.

[Efficacy of various antimicrobial agents in the treatment of epidemic typhoid fever]. / Effektivnost' razlichnykh antimikrobnykh preparatov pri lechenii épidemicheskogo briushnogo tifa.

During superepidemic of a typhoid fever in Tadjikistan the efficiency of application in clinics and of 14 antimicrobial agents representing almost all basic chemical classes was investigated. Remarkable variation of frequency and type of S. typhi resistance to these preparations up to epidemic and especially in its process was demonstrated. The absence of absolute (100%) efficacy of the investigated agents in vivo and in vitro was shown. The reasons of low efficacy of etiotropic treatment of the patients with typhoid fever are analysed.

[Changes in hemograms of patients with epidemic typhoid]. / Izmeneniia gemogrammy u bol'nykh épidemicheskim briushnym tifom.

In typhoid epidemy in Tadjikistan we studied hemograms obtained in 200 patients and 100 healthy controls matched by age. Though hematological shifts are considered to be typical of typhoid, most of the patients had no hematological disorders despite their severe condition. Hemograms were normal in half of the patients at the height of typhoid while other patients often (40-43%) had accelerated ESR, uneosinophilia and left shift of immature neutrophils.

[Specific features of the typhoid fever epidemic process in organized collective]. / Osobennosti épidemicheskogo proiavleniia briushnogo tifa v organizovannykh kollektivakh.

During the chronic water epidemic of typhoid fever in Tajikistan in 1996-1997 specific features of the epidemic process dynamics in groups of servicemen were studied in several cities. The infective agent was proved to be transmitted by the alimentary route and through everyday contacts, the water route of transmission playing the most important role. The early clinical and epidemiological signs of the water outbreak of typhoid fever and the risk factors were established. The clinical and epidemiological aspects of vaccination were analyzed.

[Treatment of pseudotuberculosis in military personnel (scientific basis and practical recommendations)]. / Lechenie psevdotuberkuleza u voennosluzhashchikh (nauchnoe obosnovanie i prakticheskie rekomendatsii.

The efficiency of 22 schemes of etiotropic therapy including treatment courses of different duration and new methods was studied basing on the results of examination of 1376 patients and retrospective analysis of 2008 cases of pseudotuberculosis in servicemen. Critical review of literature dealing with this problem was conducted. The causes of contradictory literary data have been revealed. Specificity of military service and pseudotuberculosis pathogenesis influencing on disease course and efficiency of its treatment has been shown. Taking into account our own investigations and analysis of literature there was developed the scheme of differentiated etiopathogenetic therapy of pseudotuberculosis with the use of original approaches including the method of two-stage intermittent antimicrobial therapy, stepped (parenteral-oral) etiotropic therapy, antihypoxants, gg-ABA-ergic and nootropic agents, adaptogenes, dose increase of physical load, new physiotherapeutic methods, endolymphatic administration of antibiotics.

[Clinical aspects of typhoid fever epidemic in migrants]. / Klinicheskie aspekty épidemii briushnogo tifa u migrantov.

AIM: To study clinical features of typhoid fever (TF) in migrants (subjects in military service in Tadjikistan). MATERIAL AND METHODS: In chronic water epidemic TF symptoms were studied in 547 young soldiers and officers serving in Tadjikistan with incomplete biological and/or professional adaptation. RESULTS: In most cases TF onset was acute, the course was severe with fever and intoxication. TF clinical picture was similar to that of the beginning of the XX century. Despite antibiotic resistance of the causative agent, recurrences and serious complications were rare, lethal outcomes were not registered. CONCLUSION: Relatively low frequency of recurrences and severe complications, absence of lethal outcomes in this study can be explained by long-term combined etiotropic therapy and good premorbid condition of the patients.

[The medicosocial aspects of the adaptation of servicemen]. / Mediko-sotsial'nye aspekty adaptatsii voennosluzhashchikh.

The peculiarities of servicemen' adaptation at biological, psychological and social levels under peace-time conditions and during the fighting in Chechen Republic were studied with the help of clinical and physiological, psychophysiological and psychosociological methods. The method of integral qualitative and semi-quantitative assessment of human adaptation is described. It is shown that the main stage of adaptation in servicemen lasts not less than 1 year. However the complete adaptation of military men by the end of their service usually doesn't occur. The variants of adaptation course and perspective methods of its acceleration, character and causes of dysadaptive disorders in servicemen who participated in antiterrorist operations are discussed.

[Respiratory system involvement in pseudotuberculosis]. / K voprosu o porazheniiakh dykhatel'noi sistemy pri psevdotuberkuleze.

Clinical, microbiological, x-ray and immunological examinations of 1376 patients with pseudotuberculosis and 465 patients with acute respiratory diseases of viral or coccal origin, the trends in annual morbidity for the above diseases followed up within 7 years in the populations where the patients were registered and experimental investigations on rabbits provided evidence for primarily generalized pattern of pseudotuberculosis infection and a direct relationship between pulmonary lesions in the animals and effective dose of the infectant, route of the infection. The patients had nonspecific (non-yersiniosis) lesions of the respiratory system. Frequency of the infection was greater in cold seasons, especially in those who did not complete social and biological adaptation to new conditions, and depended on seasonal fluctuations of respiratory infection morbidity in nonrandom populations.

[Operator function study by using a multipurpose digital test]. / Issledovanie operatorskikh funktsii s pomoshch'iu universal'nogo tsifrovogo testa.

The article describes the new psychophysiological test, as well as the evaluation formulas and application methods. This test makes it possible to obtain information in the conditions of long cruise about the performance capabilities of seamen who went through infectious diseases in order to study their readaptation and rehabilitation process. Traditional tests of Landolt's rings or Anfimov's letters don't dispose these possibilities. The new test provide information not only about visual analyser, but also concerning different psychophysiological characteristics of a patient.