[Prognostic value of a number of blood laboratory parameters in the use of erythropoiesis-stimulating agents in anemic patients with lymphoproliferative diseases].

AIM: To clarify the prognostic value of the baseline blood levels of endogenous erythropoietin (EE) and tumor necrosis factor-a (TNF-a) involved in the key components of the pathogenesis of anemia in lymphoproliferative diseases (LPD), the counts of reticulocytes and platelets (hematopoietic preservation indicators) in the use of erythropoiesis-stimulating agents (ESAs) to correct anemia syndrome (AS) in patients with LPD. SUBJECTS AND METHODS: The results of AS treatment with ESAs were analyzed in 48 patients with LPD. A study group comprised patients with chronic lymphocytic leukemia (n=1 3), indolent lymphomas (n=14), and multiple myeloma (n=21). Their hemograms (hemoglobin concentration, red blood cells, packed cell volume, reticulocytes, and platelets) and blood EE and TNF-alpha levels were examined before using ESAs. The hemogram was monitored during treatment. ESAs (eralfon (epoietin alpha) in 21 patients and epres in 27) were subcutaneously injected in a dose of 150 IU/kg thrice weekly (for not more than 16 weeks). A control group included 21 anemic patients with multiple myeloma who did not receive ESAs. Increasing hemoglobin concentrations up to 120 g/l was regarded as a positive response to ESA treatment. RESULTS: By and large, the efficacy of epoietin alpha was 62.5% (61.9% for eralfon and 63.0% for epres), which was significantly higher than that in the control group (23.4%; p<0.05). A number of blood laboratory parameters were found to be of value in predicting the efficacy of ESAs. The patients with the decreased baseline concentrations o EE ( <130 mlU/ml) and TNF- alfa (,15 pg/ml) were ascertained to show a positive response more frequently (80 and 92.9%, respectively; p<0.05) than those with thepredicting the efficacy of ESAs. The patients with the decreased baseline concentrations of EE (<130 mlU/ml) and TNF-a (<15 elevated concentrations of the enzymes in question. In addition, a positive response was more often recorded in patients with reticulocyte counts of more than 1% (77.4%; p<0.05) and platelets of 100-10(9)/1 (70%; p=0.05). CONCLUSION: Estimating the baseline blood levels of EE and TNF-a and the counts of reticulocytes and platelets prior to the use of ESAs enables prediction of the efficiency of erythropoiesis-stimulating therapy in anemic patients with LPD.

[The combination of chronic myeloid leukemia and multiple myeloma in one patient].

The article describes the clinical observation of a patient with simultaneous course of lymphoid and myeloid neoplasms. The patient developed two diseases--chronic myeloid leukemia (CML) and multiple myeloma (MM), which were confirmed by corroborated hemogram, myelogram, immunophenotyping of bone marrow cells, biopsy, immunohistochemical, cytogenetic, biochemical and radiological studies. Target therapy of CML with tyrosine kinase inhibitors (imatinib at the standard dose of 400 mg per day) has provided a complete cytogenetic remission at 6 months and major molecular response at 18 months of treatment. Administration of 2 courses of programmed treatment "BD" > (bortezomib + dexamethasone) resulted in a very good partial response, which was maintained through a year and a half. However, against the background of programmed treatment there were developed complications as polyneuropathy of grade 2, which was treated with thioctacide, milgamy, and anemia of grade 2, successfully treated with epoetin beta. Subsequently, the patient was administered continuously with imatinib 400 mg that kept the major molecular response. Relapsed MM was revealed in 20 months and confirmed by a full clinical and hematological examination. The absence of organ dysfunction allowed choosing a supervisory tactics for the patient.

[Supervision of the sanitary-helminthological state of soil in the inhabited areas of Moscow].

In accordance with the normative and methodical documents [3-5, 7-9], a complex of organizational, sanitary, and antiepidemic actions is performed to protect soil from causative agents of parasitic diseases in Moscow. About 2000 soil samples are annually taken from the playgrounds of children's educational establishments and apartment houses and tested. The soil contamination averages 3.2%. It has been established that there are no sanitary-and-epidemiological opinions as to the parasitic safety of sand or lids on the sand-boxes on the playgrounds from which the soil or sand samples show causative agents of parasitic diseases (most commonly toxocariasis) and which are accessible to stray and domestic dogs. In 2005, DESINBAC super having bactericidal, fungicidal, sporocidal, and virocidal activities and ovicidal properties was approved for soil disinfection in the Russian Federation. The prevention of toxocariasis is a state problem. Executive bodies, housing-and-communal services, veterinary stations, and health care services with the participation of sanitary-and-epidemiological facilities and their control must take part in solving this problem.

[The sanitary and parasitological characteristics of environmental objects in the south of Russia. Wastewaters and their precipitations].

The relative uniformity of helminthic eggs has been noted in the wastewaters of the Rostov Region, Krasnodar Territory, and the Republic ofAdygea. An ovogram is mainly presented by the eggs of Ascaris, Toxocaras, and whipworms. By taking into account incomplete dehelmintization during waste treatment, 5,000 to 1,080,000 helminth eggs may annually come into the water reservoirs where purified wastewaters are discharged, 33% remaining viable. Irrespective of the efficiency of dehelmintization, wastewaters and their precipitations continue to remain epidemiologically dangerous substrates and to create prerequisites for the spread of an invasive source in the environment, by risking the infection of the population with parasitic diseases.

[The current canine and feline parasitic diseases situation in the megapolis of Moscow].

The paper describes the epizootic situation associated with parasitic diseases in dogs and cats in the megapolis of Moscow. The situation becomes particular dangerous in the dogs kept in the flats of the city's dwellers wherein 30 (28%) out of the 107 dogs examined have been found to be infested with T. canis, T. leonine, T. vulpis, Taenia sp., D. caninum, and two protozoan species: Cystoisospora canis and C. ohioenensis. Out of the 80 cats examined, there are 22 (27.5%) infested cats. T. mystax, T. leonine, Taenia sp., and Cystoisospora felis are detectable in this group of the animals. This situation constitutes a serious hazard in the infection of the city's population with zoonoses.

[Role of parasitological laboratories in sociohygienic monitoring].

The data available in the 2003-2004 statutory forms of the Russian Federation's subjects show that the parasitological laboratories of state sanitary surveillance centers in the Russian Federation make little use of sanitary-and-parasitological studies during sanitary monitoring. Studies of the parasitological indices of foodstuffs, drinking water, wastewater and their sediments are not under way in some regions. There is a poor material and technical basis in the parasitological laboratories; the work of parasitological laboratories does not meet the requirements stipulated in Sanitary Regulations 1.2.731-99 "Safety of work with microorganisms of pathogenicity groups 3-4 and with helmints". Intralaboratory monitoring is not always under way in the parasitological laboratories. Highly skilled staff is lacking. It is necessary to extend the list of sanitary-and-parasitological studies in accordance with MU 3.2.1756-03 "Epidemiological surveillance of parasitic diseases".

[Current ascariasis situation in the Russian Federation].

In the Russian Federation (RF), ascariasis remains to be the most common geohelminthiasis, in children in particular. With its overall reduction, the prevalence of ascariasis is very uneven on the RF territory. In the past 15 years, from 1991 to 2004, there was a steady-state decrease in the incidence of ascariasis from 79.5 to 46.0 per 100,000. Its incidence rates remained higher than the average Russian ones in 33 RF subjects and lower than those in 48 subjects and began reducing in 8 subjects in the past 4 years. Of the 33 RF subjects wherein the incidence rates were constantly greater than the average Russian ones, 27 subjects are located in the natural background-favorable areas. In the past 15 years, there was an increase in the impact of socioeconomic factors on the higher incidence of ascariasis: the population's migration; the delivery and transport of Ascaris egg-contaminated greens, vegetables, berries; the development of hothouse gardening, and, as a result, the occurrence of ascariasis in the northern areas of the country, as well as the use of discharged waters for soil fertilization to grow crops. The territory of Russia was first epidemiologically districted in the context of ascariasis, by taking into account the natural background and socioeconomic factors. The area of ascariasis is on the rise. In all RF subjects, public health and social security bodies should constantly keep in mind the problem in ascariasis control and prevention.

[Trichinosis in the Republic of North Ossetia-Alania].

The present paper presents the biological, epidemiological, clinical, and immunological characteristics of trichinosis in the Republic of North Ossetia-Alania, which is based on the results of long-term studies and follow-ups and on the 1971-2002 report data from medical and veterinary services and hunt inspectorate agencies. It has established that a total of 675 clinical cases of trichinosis were recorded in Ossetia-Alania in the period under study. The incidence rate of the disease ranged from 0.5 to 16.9 cases per 100,000 individuals, which was 5-20 times or more than the average federal rate. The source of infection of human trichinosis was meat from pigs in 70.7% of the cases and that from wild animals (boars and bears) in 21.3%. Immunological examinations (red cell-linked-antigen test and enzyme immunoassay) of patients with trichinosis who had ingested infected meat, but had not fallen ill with its manifestative form revealed 81.8 and 44.2% seropositive subjects, respectively. In different periods, a positive response ranged from 3.6 to 4.7% in healthy urban residents and from 6.4 to 11.8% in rural ones. The extensiveness of invasion was 0.06 to 1.4% in pigs from individual farms and 0.0033 to 0.034% in those from collective farms. In the Digorsk Region, the trichinosis infection rates were 13.4% in dogs, 4.8% in cats, and 1.3% in murine rodents. The extensiveness of invasion in wild boars was 6.35%. A population of one capsule-forming type of Trichinella spiralis was shown to circulate in the animals of natural and synanthropic biocenoses and it is just this population that determines the specific features of an epizootic process in this area. The natural and social factors that contribute to the formation and maintenance of the activity of endemic foci of trichinosis in the Ossetia-Alania under the present socioeconomic conditions are analyzed.

[Water and intestinal parasitic diseases]. / Voda i kishechnye parazitozy.

The paper presents data on the rates of Lamblia cyst dissemination of surface water sources in foreign countries, the Russian Federation, Moscow, and the Moscow Region. It shows a role of drinking water in the spread of intestinal parasitic diseases. In accordance with parasitological parameters, specific data on improvement of methodological control of water quality are presented. The dosages of ultraviolet radiation are given in relation to water decontamination of parasitic disease germs.

[Prevalence and diagnosis of lambliasis in Perm region]. / Rasprostranennost' i kliniko-laboratornaia kharakteristika liamblioznoi invazii v Permskom regione.

The prevalence and its specific features of Lamblia invasion in children in some districts of the Perm Region, which differ in the nonstandard quality of drinking water samples are described. For the specific diagnosis of giardiasis, a serological study of the population was made by enzyme immunoassay determining specific Lamblia antibodies in the serum. The authors proposed a questionnaire that may suspect giardiasis in a child. The data obtained from the questionnaire study correlate with the positive results of enzyme immunoassay in 47.5% of cases. The clinical picture of Lamblia invasion in the examinees corresponds to the data available in the literature on the course of giardiasis.