[The disorder of cerebral circulation in patients of able-bodied age].

The study was organized to evaluate influence of risk factors on hospital mortality in patients with acute stroke because incidence of stroke in patients of able-bodied age is increasing. All cases of in-patient care of patients of able-bodied age with acute stroke (n=4118) in the Tyumen Oblast clinical hospital № 2 during 2010-2018 were analyzed. The study was based on sampling data from hospital medical records. During the analyzed period, decreasing of in-patient lethality up to 34.9% in patients of able-bodied age was observed. During the period of "therapeutic window" 60% of patients of able-bodied age admitted died. The multivariate analysis was applied to assess influence of different factors on in-patient mortality. The presence of coronary heart disease increases risk of mortality up to 47.5%, Exp(Beta)=1.475, employment - up to 66.8%, Exp(Beta)=1.668 as compared to baseline risk. The presence of arterial hypertension and remoteness of symptom onset in ln (hours) (hospital admission) decreases mortality risk up to approximately 39.7%, Exp (Beta)=0.603 and up to 24.0%, Exp (Beta)=0.760, respectively (specificity - 75.86%, sensitivity - 72.18%; overall diagnostic accuracy - 75.23%). In patients of working age the presence of coronary heart disease and elder age are risk factors of stroke. The presence of coronary heart disease and employment are risk factors of in-patient mortality. Whereas presence of hypertension and employment decreases risk of lethal outcome.

Repeat testing is essential when estimating chronic kidney disease prevalence and associated cardiovascular risk.

BACKGROUND: Investigations into chronic kidney disease (CKD) and cardiovascular disease in the CKD population may be misleading as they are often based on a single test of kidney function. AIM: To determine whether repeat testing at 3 months to confirm a diagnosis of CKD impacts on the estimated prevalence of CKD and the estimated 10-year general cardiovascular risk of the CKD population. DESIGN AND METHODS: Blood and urine samples from presumed healthy volunteers were analysed for evidence of CKD on recruitment and again 3 months later. Estimated 10-year cardiovascular risk was calculated using criteria determined by the Framingham study. Preliminary study: 512 volunteers were screened for CKD. Of the initial results, 206 indicated CKD or eGFR within one standard deviation of abnormal, and 142 (69%) of these were retested. Validation study: 528 volunteers were recruited and invited to return for repeat testing. A total of 214 (40.5%) participants provided repeat samples. RESULTS: A single test indicating CKD had a positive predictive value of 0.5 (preliminary) and 0.39 (validation) for repeat abnormalities 3 months later. Participants with CKD confirmed on repeat testing had a significant increase in estimated 10-year cardiovascular risk over the population as a whole (preliminary: 16.5 vs. 11.9%, P < 0.05; validation: 18.1 vs. 9.2%, P < 0.01). Participants with a solitary test indicating CKD had no elevation in cardiovascular risk. CONCLUSION: Repeat testing for CKD after 3 months significantly reduces the estimated prevalence of disease and identifies a population with true CKD and a cardiovascular risk significantly in excess of the general population.

[Continuous professional education of physicians in childhood and adolescence tuberculosis].

The current approaches to training pediatric phthisiatricians (phthisiopediatricians) are described. In the authors' opinion, completion of a clinical residency in not only phthisiology, but also in pediatrics is optimal to this group of specialists. The training programs for pediatric phthisiatricians differ in relation to the basic specialty: a phthisiatrician or a local phthisiatrician. Topical improvement may be made more frequently, it aims at upgrading qualification in more specialized section on phthisiology, and it is intended not only for pediatric phthisiatricians, but also for pediatricians of children's health care facilities. Training cycles in Moscow upgrades the quality of antituberculous work at the children's facilities. Difficulties in organizing the retraining of physicians of other specialties in phthisiology need normative resolution.

[The use of immunomodulator likopid in the combined treatment pulmonary tuberculosis]. / Primenenie immunomoduliatora likopida v kompleksnom lechenii tuberkuleza legkikh.

Licopid is a synthetic analogue of a cell wall component of all bacteria. The monocytic macrophageal system is the main target of licopid's action. Addition of the immunomodulator to combined therapy for patients with pulmonary tuberculosis in order to enhance phagocytic activity exerted a marked clinical effect appeared as ceased bacterial isolation in 80% of the patients, a fall in the amount of purulent sputum, no symptoms of intoxication following 2-3 weeks, accelerated resolution of infiltrative changes. The positive clinical effect coincided with the immunological one manifested as increases in the absolute counts of CD3+CD4+ and CD3+CD8+ cells, in the absorptive and bactericidal functions of phagocytes. Such effects were not observed in patients receiving routine treatment. Licopid is recommended for supplementation to the combined treatment regimen for pulmonary tuberculosis.

[Epidemiology of tuberculosis in Moscow]. / Epidemiologiia tuberkuleza v Moskve.

Tuberculous infection is no longer controllable in Moscow. Tuberculosis ranks first in the structure of morbidity caused by monoinfections. The prevalence of tuberculosis is increasing both among adults and children. Increasing incidence of forms with bacterial release is especially dangerous. Such patients represent the greatest epidemic hazard for the population. In Moscow the situation with tuberculosis is characterized by a notable reservoir of infection among socially maladapted subjects. A special department for this patient population was created in tuberculosis hospital No. 11; besides medical care, the patients are rendered social care there. The situation with tuberculosis in Russia and in Moscow requires urgent measures aimed at stabilization of the epidemiological process.

[Study of immunoglobulin E in sera and bronchoalveolar fluid of patients with pulmonary tuberculosis]. / Issledovanie immunoglobulina E v syvorotkakh i bronkhoal'veolarnoi zhidkosti bol'nykh tuberkulezom legkikh.

A highly sensitive sandwich-variety of EIA was used to measure the content of IgE in 144 sera and 59 samples of the bronchoalveolar fluid (BAF) of patients with pulmonary tuberculosis. As compared to normal persons, the content of serum IgE in the patients was significantly increased; the content of IgE in tuberculosis patients appeared as high as that in patients suffering from atopic allergy (pollenosis, bronchial asthma). The highest content of IgE was detected in patients with disseminated pulmonary tuberculosis, in the active disease phase, including those with bacterial isolation. The content of IgE was much higher in a group of patients with delayed process involution and inadequate treatment results than in a group with beneficial treatment results. The findings of the clinicoimmunological analysis permit the high content of serum IgE to be estimated as an unfavourable prognostic sign. In the BAF of patients with pulmonary tuberculosis, IgE was discovered in 30% of cases. A good correlation was noted between the IgE content in the serum and the frequency of IgE demonstration in the BAF.

[Diagnostic significance of determining specific antibodies of various isotypes in patients with pulmonary tuberculosis]. / Diagnosticheskoe znachenie opredeleniia spetsificheskikh antitel raznykh izotipov u bol'nykh tuberkulezom legkikh.

The levels of antimycobacterial antibodies of three isotypes: IgG, IgA and IgM were determined in serum of 153 patients with pulmonary tuberculosis and 136 healthy donors by the solid phase enzyme immunoassay with the sonicate as the antigen. A significant and highly reliable increase in the average levels of the antimycobacterial antibodies of the IgG, IgA and IgM classes in the serum of the patients was detected as compared to the healthy persons. A significant increase (probability of 97.5 per cent) in the antibody level in comparison to that in the healthy persons was observed in 26, 31 and 22 per cent of the patients in regard to IgG, IgA and IgM antibodies, respectively. It was shown that in every patient the level of one particular antibody isotype increased. A simultaneous significant increase in the levels of two or three antibody types was extremely rare. In this connection it was recommended to use a combined diagnostic test implying simultaneous determination of all the three antibody isotypes which provided higher frequency of tuberculosis detection (up to 67 per cent).

[Clinical x-ray characteristics of recurrent tuberculosis of the bronchopulmonary system in patients with chronic respiratory diseases]. / Kliniko-rentgenologicheskie osobennosti retsidivov tuberkuleza bronkholegochnoi sistemy u bol'nykh s khronicheskimi zabolevaniiami organov dykhaniia.

X-ray and clinical features of tuberculosis combined with lingering pneumonia were studied in 110 patients of the 7th group of dispensary registration suffering from chronic diseases of the respiratory organs. Tuberculosis recurrences in this group of patients had a torpid course, specific changes were slowly reversed, noticeable fibrosis was formed on their site. Thorough x-ray tomographic investigation not only of the pneumonia zone but also of the zone of posttubercular changes was conducted at the onset and end of pneumonia therapy to exclude tuberculosis reactivation. Frequent exacerbations of chronic diseases of the respiratory organs including complications in the form of lingering pneumonia in patients with posttubercular changes can mask early stages of tuberculosis reactivation.

[Eosinophilic exudative pleurisy as a manifestation of drug allergy]. / Eozinofil'nyi ekssudativnyi plevrit kak proiavlenie lekarstvennoi allergii.

The paper is concerned with a study in which eosinophilic exudative pleuritis was the first sign of drug allergy (penicillin, streptomycin, claphoran), also manifesting itself in fever, hemorrhagic eruption, eosinophilia in the blood. Fast recovery was achieved after discontinuation of antibacterial therapy and prescription of prednisolone. The problem of differential diagnosis of pleuritis in acute pneumonia is discussed.