[Socio-economic aspects of epidemiology of helicobateriosis].

There are considered special social and economic aspects of the epidemiology of Helicobacter pylori. These aspects acquired the particular importance for the last time due to the fact that the provision of the people with pure water has been becoming the focus of the attention of geopolitical and socio-economic interests in a number of countries. The availability ofpure drinking water serves a marker of the socio-economic state of the territory and the population living there. In Russia where different climatic conditions are deposited by considerable regional differences in the conditions of communal services caused both by various level of the socio-economic development of the territory, the supplementation with pure drinking water serves as the social determinant of the ecological conditions of the population's life. This particularly has impact on the unfeasible technical state of the water distribution systems, microorganism ecology of which can substantially affect public health. The performed by authors a specialized screening ofpresented at the official web site of the joint-stock company «Mosvodokanal¼ current data concerning the quality of drinking water consumed by 2500 Moscovites, tested for the Helicobacter pylori infection revealed no deviations from the sanitary standards in the water received by the consumers. Along with that, the comparison of the map documents of the distribution of the Helicobacter pylori infection in Moscow with the distribution of citizens' complaints of the decline of the quality of tap water has revealed a territorial fastening of the high values of the population infection rate of n^ylori and the urban sites with the greatest number of complaints. In the microbial ecology of water-distribution systems there are tightly aligned problems of their epidemiological safety, technical state and economic damage caused by corrosion as a result of microbiotic activity. In contrast to acute bacterial and viral infections which are deemed of the greatest importance when assessing the sanitary condition of water sources and water-distribution systems, the consequences of infection with H. pylori may not be manifestedfor a long time but some years later they may be manifested as serious chronic diseases (from gastritis to adenocarcinoma of the stomach and a wide range of extraintestinal pathologies), which causes great social and economic losses. Thus, the socio-economic aspect of the epidemiology of helicobacteriosis includes at least two components: the technic - the maintenance of the feasible technic and sanitary state of the water distribution systems and the medico-social - expenditures for screening and treatment of infected patients. In total they are an inseparable part of the prevention of socially-important diseases in the public health system.

[NIGHT SHIFT WORK AND HEALTH DISORDER RISK IN FEMALE WORKERS].

There was evaluated the risk to health in females employed in shift work, including night shifts. According to the data of periodical medical examinations health indices of 403 females employed in shift work, including night shifts, were compared with indices of 205 females--workers of administrative units of the same enterprise. Overall relative risk (RR) for the health disorder associated with the night shift was 1.2 (95%; confidence interval (CI): 1.09-1.28). A statistically significant increase in risk was observed in relation to uterine fibroids (OR 1.3; 95% CI: 1.06-1.54), mastopathy (OR 1.4; 95% CI: 1.2-1.6), inorganic sleep disorders (OR 8.8; 95% CI 2.6-29.8). At the boundary of the statistical significance there was the increase in the risk for obesity (OR 1.2; 95% C: 0.97-1.39), hypertension (OR 1.2; 95% CI, 0.9-1.5) and endometriosis (OR 1.5; 95% CI: 0.98-2.16). There was revealed an adverse effect of night shifts on the gestation course: ectopic pregnancy in the experimental group occurred 6.6 times more frequently than in the control group (95% CI: 0.87-50.2), and spontaneous abortion--1.7 times (95% CI: 0.95-3.22). The performed study has once again confirmed the negative impact of smoking on women's reproductive health: smoking women in the experimental group compared with the control group smokers had 2.7 times increased risk of uterine fibroids (within 1.06-7.0), the risk in non-smokers was significantly lower--1.2 (0.98-1.4). The findings suggest about a wide range of health problems related to employment on shift work, including night shifts, which indicates to the need for adoption of regulatory and preventive measures aimed to this professional group.

[On the rating of Helicobacter pylori in drinking water].

There are considered the issues related to the possibility to rate of Helicobacter pylori (H. pylori) content in drinking water. There is described the mechanism of of biofilm formation. The description refers to the biofilm formation mechanism in water supply systems and the existence of H. pylori in those systems. The objective premises of the definition of H. pylori as a potential limiting factor for assessing the quality of drinking water have been validated as follows: H. pylori is an etiologic factor associated to the development of chronic antral gastritis, gastric ulcer and duodenal ulcer, and gastric cancer either, in the Russian population the rate of infection with H. pylori falls within range of 56 - 90%, water supply pathway now can be considered as a source of infection of the population with H. pylori, the existence of WHO regulatory documents considering H. pylori as a candidate for standardization of the quality of the drinking water quite common occurrence of biocorrosion, the reduction of sanitary water network reliability, that creates the possibility of concentrating H. pylori in some areas of the water system and its delivery to the consumer of drinking water, and causes the necessity of the prevention of H. pylori-associated gastric pathology of the population. A comprehensive and harmonized approach to H. pylori is required to consider it as a candidate to its rating in drinking water. Bearing in mind the large economic losses due to, on the one hand, the prevalence of disease caused by H. pylori, and, on the other hand, the biocorrosion of water supply system, the problem is both relevant in terms of communal hygiene and economy.

[Prevention of pyloric H. pylori infection is the actual problem of modern preventive health care].

In the article there are presented data on the high prevalence of Helicobacter pylori (H. pylori) infection in Russia and its consequences, including the development of gastric cancer. There is presented the evidence of possible transmission of H. pylori with water previously underestimated. There is substantiated the necessity of preventing infection, which should include the informing of the population, compliance with hygiene standards and widespread availability of safe water.

[The study of spatial distribution of Helicobacter pylori infection rate in able-bodied population of Moscow in the course of medical examination of the manufacturing contingents].

UNLABELLED: Numerous studies have shown that Helicobacter pylori (H. pylori) is a leading etiologic factor in the development of chronic atrophic gastritis, one gastric ulcer and duodenal ulcer and gastric cancer. Effective prevention of gastroduodenal pathology requires the right information about its prevalence in the population and risk factors. The most reliable information can be obtained during medical examination of the able-bodied population, which provides in-depth clinical examination of contingents with the identification of asymptomatic pathology, detection of risk groups, the substantiation ofprophylactic measures and tracking their efficacy. MATERIAL AND METHODS: During the clinical examination of the manufacturing contingents there was performed a study of the presence of infection Helicobacter pylori (H. pylori) in 2414 people aged 19 to 74 years. For more details on the presence of gastroduodenal pathology 991 people were examined with the use of clinical methods and interviews. The aggregation of information presented in the form of estimates for its geocoding and mapping has been made. Cluster analysis was performed. RESULTS: H. pylori infection was diagnosed in 2,182 people accounting for 90.4% out of 2414 examined cases. Infections occurred equally in males--91.7% and females--89.6%. The risk of development of gastroduodenal pathology in individuals infected with H. pylori is 4.4 times greater than the risk in seronegative individuals (95%, confidence interval 1.9-6.4). Cluster analysis revealed a statistically significant clusters for the strata with a prevalence of 100% (X2 = 45.5204) and below 50% of infection rate (X2 = 7.36). It is in prospect to analyze in more detail the data relating to these areas in order to identify the factors contributing to the different degree of infection rate of residents, including the assessment of drinking water.

[Serious sepsis treatment in intensive care departments in the Czech Republic -  EPOSS Project pilot results]. / Lécba tezké sepse na pracovistích intenzivní péce v Ceské republice -  pilotní výsledky projektu EPOSS.

INTRODUCTION: Severe sepsis is still associated with significant morbidity and mortality, which is however different, as well as its management, depending on the region. What is the situation in the Czech Republic and what is the character of patients with severe sepsis is currently not known. The aim of the project is to describe the processes of care, outcome and characteristics of patients with severe sepsis admitted to the intensive care department of the Czech Republic. METHODS: This is a multicentre and observational project with retrospective enrollment of patients who meet the criteria for severe sepsis before or within 24 hours after admission to selected intensive care units (ICU EPOSS). RESULTS: 394 patients were analyzed. Median age at admission was 66 (56- 76) years, males predominated (58.9%) and the median APACHE II score on admission was 25 (19- 32). Patients were predominantly medical (56.9%) and most were secondary admitted from other ICU (53.6%). Meeting the criteria of severe sepsis was most frequently within the period (± 4 hours) of admission the EPOSS ICU (77.6%). Median total fluid intake during the first 24 hours was 6,680 (4,840- 9,450) ml. Most patients required mechanical ventilation (58.4%). Compliance with the resuscitation bundle of severe sepsis in our group was very good and was associated with lower mortality of patients. Most frequently, the EPOSS ICU length of stay (LOS) was 7 (3- 15) days and median hospital LOS was 13 (8- 28) days. Hospital mortality in our cohort was 35.8%. CONCLUSION: Introducing the project, which in its first stage obtained valuable and internationally comparable data about patients with severe sepsis admitted to the involved ICU in the Czech Republic.

[Approaches to the study of the role of water factor in prevalence of Helicobacter pylori infection].

For the present time it became apparent that Helicobacter pylori (Hp) is present in the surface water groundwater wells, in the water from water distribution system. WHO classifies Hp to a group of emerging pathogens for epidemiological surveillance of diseases associated with water. The study, of various aspects of the permeation of Hp into the body of water requires an integrated approach including microbiological, hygienic and epidemiological components. Microbiological research component includes the study of Hp in a water medium at the stages of water preparation, distribution over nettworks and in end users, sanitary hygienic component--hygienic assessment of sources of water supply. The survey of organized cohorts, regularly undergoing periodic health examinations can be one of epidemiological approaches. Using a scanning method and graphical data binding to an electronic map of the studied area with account for residing of examined patients will permit to identify areas and microsections with the highest rates of infection and their conjugation with the character of water using and condition of water supply network

[Testing of the system of biochemical and immunological indices of the state of population health in the survey of residents of Moscow, exposed to ambient air pollution].

New biomarkers of effect of some controlled ambient air pollutants (formaldehyde, carbon monoxide and TSP) were found in two surveys of Moscow residents (apparently healthy and outpatients with allergic diseases) with a help of screening system of biochemical and immunological parameters. Possible mechanisms of the effects, including interference of atmospheric carbon monoxide and sulfur dioxide with corresponding endogenous second messengers, are discussed.

[Phenotypic polymorphism of biomedical parameters of the health status in hygienic studies].

The paper presents the results of investigating the phenotypic polymorphism of a number of biochemical and immunological parameters (the values of oxidative stress, the activity of catalase and glutathione-S-transferase in red blood cells, the serum levels of catecholamines, tumor-necrosis factor-?, and IgG antibody subclasses) in the authors' hygienic studies of genotypic and nongenotypic population samples.

[Current role of methylprednisolone in the treatment of acute spinal cord injury]. / Soucasný pohled na uzívání methylprednisolonu v lécbe akutního poskození míchy.

High doses of methylprednisolone (MPSS) came into use as part of a therapeutic protocol for acute spinal cord injuries following the published results from the NASCIS II study in 1992; they soon became a standard of care around the world. However, the results of this study have been critically reviewed and questioned by many authors since the beginning. The major argument is based on the fact that its effectiveness in reducing post-injury neurological damage has not been conclusively proved; in addition, there has been increasing evidence of serious side effects of steroids administered at high doses. In the Czech Republic, as part of pre-hospital care, MPSS according to the NASCIS II (or NASCIS III) protocol is used in all regional centres of emergency medical service. In the Czech spinal surgery centres involved in treating acute spinal cord injuries, there are 19 of them, attitudes towards the use of MPSS vary. In 16% of the centres a certainty of its beneficial effect is still maintained, faith in its effect together with fear of a "non-lege artis" procedure is the reason for MSPP use in 21%, and the fear of sanctions only leads to its use in 63% of the centres. There is no standard practice in application of the NASCIS II and NASCIS III protocols and no standard exclusion criteria exist. The two protocols are used equally, and one institution has its own modification. The recommended MPSS dose is administered with no exception in 63% of the centres; dose adjustment is employed according to the form of spinal cord lesion in 11%, the level of spinal cord injury in 5%, associated diseases in 16% and patient age in 11% of the spinal surgery centres. After the results of studies on MPSS administration in acute spinal cord injury have been analysed, many medical societies have changed their recommendations. In view of later relevant publications it is no longer possible to regard MPSS administration as a standard of cure for acute spinal cord injury. Current evidence suggests that MPSS administration in a 24-hour regimen after an initial dose given within 8 hours of injury is the therapeutic procedure that needs individual consideration in each patient according to their state of health and potential complications. MPSS administration at an interval longer than 8 hours after injury and for more than 24 hours is not justified, nor is it justified to use a high MPSS dose at the place of injury by an emergency ambulance crew. Key words: corticosteroids, methylprednisolone, spinal cord trauma, neurological damage.

[Epidemiological characteristics of Helicobacter pylori infection in Moscow].

The authors studied the prevalence and a number of epidemiological features of Helicobacter pylori (Hp) infection in Moscow. A prophylactic medical examination revealed the infection in 863 working residents of the megapolis. A mini-invasive study was used. Enzyme immunoassay was carried out to determine serum IgG antibodies against Hp. The authors' questionnaire was used in 634 interviews. There was an extremely high incidence (88%) of Hp infection. The prevalence of the infection was found to be related to age, social status (social position, educational level), living conditions (shared or hostel habitation, no sewerage system), contact with waste waters. No association was found between the rate of the infection and the examinees' gender, the intake of raw Moscow tap drinking water, and the contact with domestic animals. Moscow was rated among the cities with a high prevalence of Hp infection. The study revealed a number of epidemiological features of the infection in the megapolis, a knowledge of which is required to elaborate measures for its prophylaxis and the prevention of its associated diseases.

[Iatrogenic injuries of the pulmonary artery]. / Iatrogenní poranení plicní artérie.

The injury of major thoracic vessels always presents life threatening condition. In our case report we present iatrogenous pulmonary artery lesion caused by Swan-ganz catheter during invasive intraluminal pulmonary pressure measurement as a part of examination for cardiosurgical mitral valve replacement. There are no files describing successfully treated patients with vast pulmonary artery trunk injury rather than particular case reports. Although severe iatrogenous injury is being discussed, the outcome for the patient is thank to early surgical treatment (the application of recombinant coagulation factor VII - Novoseven, blood recuperation, therapeutic hypothermia) and professional postoperative care maximally beneficial. In the discussion and conclusion authors summarize therapeutical procedures that led to saving a patient's life.

[Comprehensive examination of able-bodied populations from different Moscow districts to maintain and correct the health of healthy individuals].

A total of 1038 Muscovites (740 males and 298 females) aged 20 to 60 years were examined using a broad range of clinical and diagnostic methods. In the study cohort, the prevalence of all diseases taken together was 1533 cases per 1000 examinees, the number of cases being 1108.1 and 2590.6% per hundred among men and women, respectively. In males, endocrine diseases (27.3%) rated first, next were cardiovascular (23.5%) and digestive (18.8%) diseases that occupied the second and third places, respectively. In females, diseases of genital organs (breast, ovaries, corpus and cervix uteri) were the most common pathology (about 50%), cardiovascular (15.8%) and digestive (10.6%) diseases ranked second and third, respectively. Metabolic syndrome was virtually equally present in both sexes: 22.7% in males and 26.5% in females. The application of this approach can reveal abnormalities in their early stage, follow their course, and develop packages of adequate preventive measures.

[Use of micronuclear test to the human buccal mucosal epithelium].

The paper presents microphotos of anomalies of the human buccal mucosal epitheliocytic nucleus and gives criteria for their identification. Two procedures for making a scrape from the buccal mucosa were compared. The smears prepared from the samples taken with a urogenital brush showed the lower frequency of cells with micronuclei, protrusions of the "broken egg" and "tongue" types, vacuolated cells, as well as cells with nuclear pyknosis and lysis than those prepared with a rough scrape spatula. The nuclear frequency of cells with condensed chromatin in such smears was higher than that in the rough scrape. In addition, the authors show a relationship of the frequency of cells with the binuclei, perinuclear vacuole, nuclear pyknosis, and condensed chromatin in the nucleus, and absorbed apoptotic (residual) bodies to the examinee's age.

[A methodological scheme for examination of the urban population, by making multilevel assessments of exposure to ambient air pollutants].

A novel methodological design comprising multilevel assessments of exposures of examinees to controlled ambient air pollution according to the data of route stations was developed to examine the population of large towns. The design was tested in 4 surveys of Moscow residents (apparently healthy and outpatients with a number of chronic diseases). The findings indicate the fundamental possibility of altering the traditional differential design of biomedical surveys of the population, by introducing more evidence-based regression analyses and dividing the contributions of individual chemicals to the observed changes in health indices.

[A complex approach to evaluation of human genome instability].

In this study, evaluation of genome instability in individuals exposed to chemical compounds included detection of the genetic polymorphism of some xenobiotic metabolic enzymes (CYP1A1, CYP1E1, PON1, GSTM1, GSTT1), as well as measurement of oxidative state chemiluminescent variables and the level of cytogenetic damage. According to the study, the level of chromosomal aberrations in peripheral blood lymphocytes shows a strong correlation with PON54 left allele and GSTM1 null genotype, and can be described by the polynomial function of blood plasma luminol-dependent chemiluminescence. The frequencies of micronuclei in buccal epithelium displayed a weak association with GSTT1 null genotype.

[Analysis of virulent and avirulent strains of Vibrio cholerae by the nest polymerase chain reaction]. / [Aanaliz virulentnykh i avirulentnykh shtammov Vibrio cholerae metodom gnezdovoi polimeraznoi tsepnoi reaktsii.

The detection of cholera enterotoxin in environmental objects and isolation of patients are considered to be the most reliable indices of that the cholera agent is present. Described in the case study is a method of nested polymerase chain reaction (PCR) based on amplifying the ctxA gene fragment coding subunit A of enterotoxin. A possibility was shown to use the above method to confirm the virulence of strains Vibrio cholerae isolated from different sources. The method was tested with 18 virulent and avirulent strains V. cholerae as well as (for the sake of verifying the analysis specificity) with DNAs of other human-pathogenic microorganisms and with the human genome DNA. The results showed a high efficiency of nested PCR in detecting the pathogenicity of cholera-agent strains.

[Use of nested PCR in detection of the plague pathogen]. / Primenenie gnezdovoi PTsR v detektsii vozbuditelia chumy.

Causative agents of plague, i.e. bacterium Yersina pestis (in the subcutaneous tissues of rodents) and their cutaneous parasites need to be isolated to enable plague prevention. A comparatively new method of polymerase chain reaction (PCR) opens up new possibilities of determining Y. pestis just within several hours and without any cultivation. The article contains a description of the PCR-method, which makes it possible to distinguish the culture of Y. pestis from cultures of other microorganism, including speci of Yersina. The method is of the cluster-type, i.e. it is made up of subsequent PC reactions with the substrate for the second reaction being the product of the first one. The cluster nature of the method preconditions a higher sensitivity and specificity versus the ordinary PCR.