RESUMEN
Individual features of age-related changes in the function of the neuroendocrine systems are an important problem as the basic component of a personalized approach to predicting and treating age-related pathologies. We studied the age-related features of the function of the hypothalamic-pituitary-thyroid axis in laboratory primates with depression- and anxiety-like behavior (DAB). It was found that in young female rhesus monkeys with DAB, the basal and thyrotropin-releasing hormone-stimulated levels of thyroid-stimulating hormone were significantly lower than in young animals with standard behavior (control). During aging, the levels of thyroid-stimulating hormone increased in DAB animals and free thyroxine concentrations decreased both at baseline (fasting) and in response to the thyrotropin-releasing hormone test, while in animals with standard behavior, only a trend towards similar hormonal changes was revealed.
RESUMEN
Regions of Arctic Zone and Far North of Russia have a weak social infrastructure, including regional segments of the state healthcare system. The study of citizens satisfaction with the healthcare system is one of the leading methods for assessing its effectiveness. Citizens satisfaction may be distorted by their health literacy (HL). Half of the 'healthy' citizens (51.1%) had an excellent or sufficient level of general GVH; 2/3 of the patients of medical organizations (70.4%) had an insufficient or problematic level of general HL. The level of citizens` satisfaction with domestic healthcare is determined by their clinical status - it is higher in the group of patients (60.1%) than in the group of 'healthy' people (31.0%). Patients evaluate it more loyally in comparison with health people. Respondents with an insufficient HL evaluate the health care system less loyally. The high level of HL allows patients to assess the results of the work of the domestic health care system more objectively in comparison with healthy citizens. The aim of this study is to assess the satisfaction of the residents of the circumpolar region of Russia (the Arkhangelsk Oblast) with the regional segment of the State Healthcare System, depending on the level of their HL.
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Alfabetización en Salud , Humanos , Satisfacción Personal , Encuestas y Cuestionarios , Atención a la Salud , Estado de SaludRESUMEN
The medical rehabilitation in all areas of medicine is developing actively and rapidly. In cardiology, medical rehabilitation contributes to prevention of recurrent myocardial infarction and other complications in patients with myocardial infarction. The study evaluated impact of anaerobic exercise and strength rehabilitation program on hemodynamics in patients with myocardial infarction using the David back concept mechanotherapy method.
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Infarto del Miocardio , Terapia por Ejercicio , Humanos , Infarto del Miocardio/terapiaRESUMEN
The article presents historical essays concerning each method of rehabilitation, period of its revision depending on time and pathological etiology of each disease, application of rehabilitation (health path, mechanotherapy), different modes of choosing each method of rehabilitation. The term "rehabilitation" became widespread after adoption of the Federal Law No. 181 of November 24, 1995 "On social protection of disabled people in the Russian Federation". This is the set of measures targeted to recuperation of functional reserves of organism, improving quality of life, maintaining working capacity of patient, one's integration into society, reducing incapacitating states impact to support people with impaired functions to adapt to new conditions of life in society. The rehabilitation and habilitation are processes targeting to ensure that the disabled could be able to achieve and maintain optimal levels of physical, sensory, intellectual, psychological and/or social functioning. The rehabilitation covers wide range of activities, including rehabilitative medical care, physiotherapy, psychotherapy, logopedics and ergotherapy and supportive services too. The disabled are to have access to both general medical services and appropriate rehabilitation services.
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Personas con Discapacidad , Medicina , Humanos , Calidad de Vida , Federación de Rusia , Ajuste SocialRESUMEN
At all stages of recovery after myocardial infarction (MI), the expansion of physical activity of elderly patients is one of the most important components. Of course, certain restrictions can reduce the load on the myocardium, reduce its oxygen needs and create conditions for early healing. Subsequently, depending on the dynamics and indicators of the cardiovascular system, the elderly patient is transferred from one stage of activity to another, the level of blood pressure, the number of heartbeats, the presence of arrhythmia, electrocardiogram data, EchoCG data, as well as individual load tolerance are evaluated. To date, there is a huge selection of optimal options for selecting methods of medical rehabilitation for elderly patients who have suffered a MI, and one of them is mechanotherapy. The mechanical therapy program of the David Back Concept complex - strength training is a set of simulators for working on the back muscles. The medical and diagnostic complex is designed for the diagnosis, treatment and prevention of pathologies of the musculoskeletal system, as well as for the rehabilitation of patients after surgical interventions and spinal injuries. Medical rehabilitation of elderly patients with coronary heart disease and after a MI through mechanotherapy, the program of the David Back Concept complex, provides for the restoration of their physical and social status to an optimally achievable level, determined by the capabilities of adaptive mechanisms.
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Enfermedad Coronaria , Infarto del Miocardio , Anciano , Electrocardiografía , Ejercicio Físico , Humanos , Infarto del Miocardio/diagnóstico , Estatus SocialRESUMEN
Cognitive impairment or delirium occurs in about 40% of elderly patients after surgery. The increasing number of elderly people has led to a significant increase in the number of cases of postoperative cognitive dysfunction (POCD). This is one of the most important medical and social problems, the analysis of which is especially difficult, since it requires the coordination of a large number of specialties: anesthesiology, surgery, neurology, psychiatry, neuropsychology, as well as fundamental neurosciences. Thus, a systematic multidisciplinary approach that takes into account all possible factors affecting the condition of patients should be considered. The article is devoted to the main aspects of the pathogenesis, prevention and treatment of POCD.
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Trastornos del Conocimiento , Disfunción Cognitiva , Delirio , Anciano , Cognición , Trastornos del Conocimiento/diagnóstico , Trastornos del Conocimiento/epidemiología , Trastornos del Conocimiento/etiología , Disfunción Cognitiva/epidemiología , Disfunción Cognitiva/etiología , Humanos , Complicaciones Posoperatorias/epidemiología , Periodo PosoperatorioRESUMEN
AIM OF STUDY: Comparison of the data obtained by ultrasound examination of a pregnant woman with antenatal death of the fetus and stillborn child, with the autopsy results. MATERIALS AND METHODS: The protocols of ultrasound examinations and the autopsy protocols of 126 fetuses that died antenatally were analyzed. RESULTS: In our study of 126 patients, 95 showed no structural changes either during ultrasound examination or during further pathomorphological examination. The ultrasound conclusion corresponded to the results of classical autopsy in the presence of congenital malformations in two patients. 29 pregnant women had discrepancies in the results of ultrasound examination and subsequent pathomorphological examination. At the same time, in 7 patients there was an overdiagnosis, in 22 - an underdiagnosis. CONCLUSIONS: Ultrasound diagnostics in cases of suspected fetal death does not allow verification of the diagnosis, ultrasound examination of a pregnant woman with antenatal fetal death and post-mortem ultrasound examination of a stillborn cannot replace autopsy, pathoanatomical and histological examinations.
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Muerte Fetal , Feto , Autopsia , Femenino , Humanos , Embarazo , Mortinato , Ultrasonografía PrenatalRESUMEN
In this study was made an attempt to reveal additional laboratory markers of white blood for preliminary estimation level of HIV-infection development. Essentially such markers these are in progress without complex equipment and expensive reagent. It was studied alterations of basic values cells of innate and acquired immunity of peripheral blood HIV-infected individuals with and without antiretroviral treatment (ART) during infection. It was estimate value leukocytes, neutrophils, monocytes, lymhpocytes, T-lymhpocytes, CD4+, CD8+ T-cells, CD4/CD8 index. It was used the first analysis in the time of registration for regular medical check-up and the intermediate derived during 2017-2018 years. Patients without ART and with ART before and after treatment had rates of leukocytes, lymhpocytes, T-lymhpocytes, monocytes and neutrophils within the normal guideline. Essential changes were observed in basic conventional laboratory parameters evaluation of HIV-infection dynamic (parameters of CD4+, CD8+ T-cells, CD4/CD8 index). Thereby it was impossible to reveal supplementary immunological markers of HIVinfection.
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Inmunidad Adaptativa , Infecciones por VIH/inmunología , Inmunidad Celular , Terapia Antirretroviral Altamente Activa , Relación CD4-CD8 , Linfocitos T CD4-Positivos/inmunología , Linfocitos T CD8-positivos/inmunología , Infecciones por VIH/tratamiento farmacológico , HumanosRESUMEN
An increasing number of studies are devoted to the study of the relationship of mental disorders, such as depression and anxiety, with the risk of developing type 2 diabetes mellitus. However, in the literature there are practically no publications on the study of the relationship of the features of higher nervous activity, in particular, adaptive behavior, in healthy individuals with the risk of developing age-related dysfunction of the pancreatic islet apparatus (PIA). The purpose of this study was to investigate features of the functioning of the PIA during aging in individuals with normal standard behavior (SB), as well as anxiety- and depressive-like behavior (DAB) in experiments on nonhuman primates. 76 physically healthy young mature and old female rhesus monkeys with SB and DAB were used in the experiments. Old animals were divided into subgroups with normal (NW) and excess (EW) body weight. All young animals were characterized by NW. The function of PIA was assessed using a glucose tolerance test. Intergroup differences in the functioning of the PIA in young animals were revealed, which were characterized by signs of impaired early insulin response, apparently due to a decrease in the sensitivity of ß-cells of the pancreas to glucose. With aging, the function of the PIA was damaged in all animals, but the features of its changes depended on both the affiliation to a particular behavioral group and the animal's body weight. During aging in animals with SB, the development of relative insulin resistance of peripheral tissues was observed, accompanied by impaired glucose tolerance and a compensatory increase in the secretory activity of the PIA, which were more pronounced in animals with EW. Age-related dysfunction of the PIA in animals with DAB and NW was similar with age-related changes in the PIA function in animals with SB and NW. At the same time, with aging, animals with DAB and EW showed a more significant peak concentration of glucose than that of old animals with SB and EW, accompanied by a minimum «disappearance¼ rate of glucose from the circulation and significantly lower insulin secretion than this in animals with SB and EW. Thus, age-related dysfunctions of the PIA in primates with SB and DAB are unidirectional with the development of insulin resistance, impaired glucose tolerance and a compensatory increase in insulin secretion, which, however, in old animals with DAB and EW are accompanied by exhaustion of the PIA function, increasing the risk of developing type 2 diabetes mellitus.
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Envejecimiento , Conducta Animal , Diabetes Mellitus Tipo 2 , Islotes Pancreáticos , Páncreas , Primates , Adaptación Psicológica , Animales , Conducta Animal/fisiología , Femenino , Insulina , Macaca mulatta , Páncreas/fisiología , Primates/fisiologíaRESUMEN
We studied the effect of NO synthesis blockade on the hydrouretic function and the state of renal interstitial matrix in WAG rats with normal blood vasopressin level and Brattleboro rats lacking endogenous vasopressin. In WAG rats, impaired osmotic concentration accompanied by an increase in the content of histochemically detectable glycosaminoglycans in the inner medullary interstitium was observed under conditions of NO synthesis blockade. In Brattleboro rats, NO synthesis inhibition, on the contrary, induced an antidiuretic response without significant changes in the renal extracellular matrix. These findings attested to a significant influence of NO on the urine concentration process. Morphofunctional changes in the kidneys under conditions of NO synthesis blockade are determined by blood vasopressin level.
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Matriz Extracelular/metabolismo , Riñón/metabolismo , Óxidos de Nitrógeno/metabolismo , Vasopresinas/sangre , Animales , Femenino , Glicosaminoglicanos/metabolismo , Ácido Hialurónico/metabolismo , Masculino , RatasRESUMEN
Historical development of mitral valve surgery at Petrovsky Russian Research Center for Surgery is described in the article. Evolution of artificial heart valves design and development of surgical techniques are presented.
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Implantación de Prótesis de Válvulas Cardíacas , Válvula Mitral , Prótesis Valvulares Cardíacas , Humanos , Insuficiencia de la Válvula Mitral/cirugía , Federación de RusiaRESUMEN
It was studied in vitro the immunomodulatory effect of plasma HIV-infected individuals on expression of activation markers when used as a model neoplastic cell line MT-4. Carrying out researches indicated the variation in expression of the activation markers CD28+, CD38+, HLA-DR+ и CD69+. Change dynamics of these indices showed that these proteins can to consider as markers for level evaluation of patients immune system during used of plasma HIV-infected individuals with and without antiretroviral treatment (ART). Analysis revealed reduction of cells activation potential in plasma of patients with ART presence and rise without treatment. Examinations of the expression proteins CD28, CD38, HLA-DR и CD69 MT-4 cells and plasma of patients with HIV-infection application can have prognostic value for infection monitoring and efficacy of different therapeutic approaches.
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Infecciones por VIH/sangre , ADP-Ribosil Ciclasa 1/análisis , Antirretrovirales/uso terapéutico , Antígenos CD/análisis , Antígenos de Diferenciación de Linfocitos T/análisis , Antígenos CD28/análisis , Línea Celular Tumoral , VIH , Infecciones por VIH/tratamiento farmacológico , Antígenos HLA-DR/análisis , Humanos , Lectinas Tipo C/análisis , Activación de LinfocitosRESUMEN
We designed a new complex drug with antiallergic effect containing, in addition to the main component loratadine, a phytocomplex for an extra therapeutic effect. A collection of plants with sedative activity is chosen and the optimal agent for extraction of bioactive compounds (40% ethanol) and optimal degree of plant fragmentation are determined. Chemical composition of the sedative tea is evaluated by reverse phase HPLC. The marker components of the species are detected: xanthohumol and isoxanthohumol - Humulus lupulus cone components, Mentha piperita rosmarinic acid, and scutellareine, Menyanthes trifolia element - quercetin-3-rutinoside, and caffeic acid. Standardization of the species by the absolute graduation method in conversion to quercetin-3-rutinoside is suggested.
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Antagonistas de los Receptores Histamínicos H1/aislamiento & purificación , Humulus/química , Mentha piperita/química , Fitoquímicos/aislamiento & purificación , Supositorios/síntesis química , Apigenina/química , Apigenina/aislamiento & purificación , Ácidos Cafeicos/química , Ácidos Cafeicos/aislamiento & purificación , Cromatografía Líquida de Alta Presión , Cinamatos/química , Cinamatos/aislamiento & purificación , Depsidos/química , Depsidos/aislamiento & purificación , Etanol/química , Flavonoides/química , Flavonoides/aislamiento & purificación , Antagonistas de los Receptores Histamínicos H1/química , Antagonistas de los Receptores Histamínicos H1/normas , Humanos , Fitoquímicos/química , Fitoquímicos/normas , Extractos Vegetales/química , Propiofenonas/química , Propiofenonas/aislamiento & purificación , Rutina/química , Rutina/aislamiento & purificación , Solventes/química , Xantonas/química , Xantonas/aislamiento & purificación , Ácido RosmarínicoRESUMEN
In the course of adaptation of the rat kidney collecting duct cells to hypo-osmotic medium, the organic anion transporter inhibitor probenecid reduced significantly the regulatory cell volume decrease in response to a hypotonic shock. Both probenecid and hypotonic shock delayed significantly the entry into a cell of the fluorescent dye calcein, which exists as anion at neutral pH. Thus, the organic osmolyte transport plays an important role in the regulatory decrease of the principal cell volume under the hypo-osmotic conditions.
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Túbulos Renales Colectores/fisiología , Riñón/fisiología , Presión Osmótica/fisiología , Equilibrio Hidroelectrolítico/fisiología , Animales , Tamaño de la Célula/efectos de los fármacos , Concentración de Iones de Hidrógeno , Riñón/metabolismo , Túbulos Renales Colectores/metabolismo , Transportadores de Anión Orgánico Sodio-Independiente/metabolismo , Probenecid/farmacología , RatasRESUMEN
The functional properties of the invasive Heracleum sosnowskyi were compared with those of the native Heracleum sibiricum. The leaf and root traits, as well as those of a whole plant and of the mycorrhiza formation, were studied. H. sosnowskyi can fulfill the high-productivity potential only under the optimum availability of resources (especially water), while it is poorly adapted to maintain a high physiological activity under the unfavorable soil conditions. An important component of the H. sosnowskyi invasiveness is an ability to utilize rapidly resources in both the above- and underground areas at the optimum conditions.
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Heracleum/crecimiento & desarrollo , Especies Introducidas , Hojas de la Planta/crecimiento & desarrollo , Raíces de Plantas/crecimiento & desarrollo , Heracleum/microbiología , Micorrizas/crecimiento & desarrollo , Hojas de la Planta/microbiología , Raíces de Plantas/microbiología , Microbiología del Suelo , Simbiosis/fisiología , Agua/químicaRESUMEN
BACKGROUND: Endothelial and smooth muscle cells are considered promising resources for regenerative medicine and cell replacement therapy. It has been shown that both types of cells are heterogeneous depending on the type of vessels and organs in which they are located. Therefore, isolation of endothelial and smooth muscle cells from tissues relevant to the area of research is necessary for the adequate study of specific pathologies. However, sources of specialized human endothelial and smooth muscle cells are limited, and the search for new sources is still relevant. The main goal of our study is to demonstrate that functional endothelial and smooth muscle cells can be obtained from an available source-post-surgically discarded cardiac tissue from the right atrial appendage and right ventricular myocardium. METHODS: Heterogeneous primary cell cultures were enzymatically isolated from cardiac explants and then grown in specific endothelial and smooth muscle growth media on collagen IV-coated surfaces. The population of endothelial cells was further enriched by immunomagnetic sorting for CD31, and the culture thus obtained was characterized by immunocytochemistry, ultrastructural analysis and in vitro functional tests. The angiogenic potency of the cells was examined by injecting them, along with Matrigel, into immunodeficient mice. Cells were also seeded on characterized polycaprolactone/chitosan membranes with subsequent analysis of cell proliferation and function. RESULTS: Endothelial cells isolated from cardiac explants expressed CD31, VE-cadherin and VEGFR2 and showed typical properties, namely, cytoplasmic Weibel-Palade bodies, metabolism of acetylated low-density lipoproteins, formation of capillary-like structures in Matrigel, and production of extracellular matrix and angiogenic cytokines. Isolated smooth muscle cells expressed extracellular matrix components as well as α-actin and myosin heavy chain. Vascular cells derived from cardiac explants demonstrated the ability to stimulate angiogenesis in vivo. Endothelial cells proliferated most effectively on membranes made of polycaprolactone and chitosan blended in a 25:75 ratio, neutralized by a mixture of alkaline and ethanol. Endothelial and smooth muscle cells retained their functional properties when seeded on the blended membranes. CONCLUSIONS: We established endothelial and smooth muscle cell cultures from human right atrial appendage and right ventricle post-operative explants. The isolated cells revealed angiogenic potential and may be a promising source of patient-specific cells for regenerative medicine.
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Prótesis Vascular , Células Endoteliales/citología , Miocardio/citología , Miocitos del Músculo Liso/citología , Neovascularización Fisiológica , Diseño de Prótesis , Animales , Diferenciación Celular , Proliferación Celular/efectos de los fármacos , Separación Celular , Supervivencia Celular/efectos de los fármacos , Células Cultivadas , Quitosano/farmacología , Células Endoteliales/efectos de los fármacos , Células Endoteliales/metabolismo , Células Endoteliales/ultraestructura , Humanos , Ratones SCID , Miocitos del Músculo Liso/efectos de los fármacos , Miocitos del Músculo Liso/metabolismo , Miocitos del Músculo Liso/ultraestructura , Neovascularización Fisiológica/efectos de los fármacos , Molécula-1 de Adhesión Celular Endotelial de Plaqueta/metabolismo , Poliésteres/farmacología , Cuerpos de Weibel-Palade/metabolismoRESUMEN
The need for efficient and cost-effective cholera vaccine hasn't lost its actuality in view of the emergence of new strains leading to severe clinical forms of cholera and capable to replace strains of the seventh.cholera pandemic, and in connection with the threat of cholera spreading beyond the borders of endemic countries. In this review data from literature sources are presented about the use of outer membrane proteins, vesicles, cell ghosts of the cholera causative agent in specific prophylaxis and diagnostics of the disease.
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Proteínas de la Membrana Bacteriana Externa , Estructuras de la Membrana Celular , Vacunas contra el Cólera , Cólera , Vibrio cholerae , Proteínas de la Membrana Bacteriana Externa/química , Proteínas de la Membrana Bacteriana Externa/inmunología , Proteínas de la Membrana Bacteriana Externa/metabolismo , Estructuras de la Membrana Celular/química , Estructuras de la Membrana Celular/inmunología , Estructuras de la Membrana Celular/metabolismo , Cólera/diagnóstico , Cólera/epidemiología , Cólera/inmunología , Cólera/metabolismo , Vacunas contra el Cólera/química , Vacunas contra el Cólera/inmunología , Vacunas contra el Cólera/metabolismo , Humanos , Vibrio cholerae/química , Vibrio cholerae/inmunología , Vibrio cholerae/metabolismoRESUMEN
The aim of this study was to determine the role remaxol in complex intensive therapy of various jorms gipoergosis dur- ing the perioperative period in patients with hepatopancreatoduodenal zone malignancies. The treatment of 48 patients was analyzed. Immediately prior to surgery, at random, patients were divided into primary (n = 26) and control group (n = 22). In the study group for compensation the energy deficient states and organ hypoxia in the pancreas and the liver during the intra- and postoperative periods remaxol was included in the infusion therapy, the introduction ofwhich had been began before the start of anesthesia. In the control group antihypoxants weren't used. Integral assessment of prognosis and severity on a scale SAPS II and APACHE II. Status of energy and the type of energy deficit was estimated by the transport of oxygen and the concentration of lactate. In order to determine the level of stress exposure and the for- mation of adaptive reactions examined quantitative and qualitative composition of the peripheral blood. The study was conducted prior to surgery, on the 2nd and 5th day perioperative period. Inclusion in the scheme of metabolic remaxol program in the perioperative period in patients with malignant diseases of hepatopancreatoduodenal zone promotes the reduction of different types ofgipoergosis, efficient delivery and oxygen consumption, the adequacy of tissue oxygenation and restoration of adaptive physiological reactions such as.
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Adaptación Fisiológica/efectos de los fármacos , Neoplasias del Sistema Digestivo/cirugía , Metabolismo Energético/efectos de los fármacos , Atención Perioperativa/métodos , Succinatos/uso terapéutico , Adulto , Anciano , Neoplasias del Sistema Digestivo/metabolismo , Humanos , Persona de Mediana Edad , Consumo de Oxígeno/efectos de los fármacos , Estudios Prospectivos , Método Simple Ciego , Succinatos/administración & dosificación , Resultado del TratamientoRESUMEN
Psychoemotional stress is one of the leading cardiovascular risk factors. The aim of this study was to explore manifestations of arterial hypertension (AH) in young men employed in the stress associatedfield works. Material and methods. A total of 68 young men, exposed to job stress (JS) of different severity during 1 to 5 years were surveyed. The control group was formed of persons whose daily work was unrelated to operational activities. The study included ambulatory monitoring (AM) blood pressure (BP) on different days of the week, comparing the results of the office and DMBP determination and assessment of resistance to a variety of diagnostic loads. Results. The study revealed an increase of AMBP indicators during the working day and their normalization at weekend. The comparison of the results of office and ambulatory determination of BP demonstrated that different forms of stressful AH (stable, isolated office and latent) occurred significantly more often than in the control group. These changes almost completely disappeared at weekends. The tolerance ofpsychoemotional testing was much worse than that of traditional exercises. It is proposed to more extensively use AMBP during regular medical examinations of young men exposed to JS in order to establish a timely differential diagnosis of various forms of stressful hypertension.
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Hipertensión , Estrés Laboral , Estrés Psicológico , Adulto , Monitoreo Ambulatorio de la Presión Arterial/métodos , Diagnóstico Diferencial , Diagnóstico Precoz , Femenino , Humanos , Hipertensión/diagnóstico , Hipertensión/etiología , Hipertensión/prevención & control , Hipertensión/psicología , Aplicación de la Ley , Masculino , Estrés Laboral/diagnóstico , Estrés Laboral/fisiopatología , Factores de Riesgo , Estrés Psicológico/diagnóstico , Estrés Psicológico/fisiopatologíaRESUMEN
The wide circulation of Klebsiella bacteria in water ofwater objects of different climatic zones of Russia and various function is established. So bacteria of the Klebsiella strain are in superficial sources of the centralized water supply depending on extent of their biological and chemical pollution; underground waters at the unprotected water-bearing horizons; in drinking water at insufficiently effective system of its cleaning and disinfecting. Klebsiella circulating in water was shown to keep properties of pathogenicity and a virulence, possess resistance both to modern preparations and disinfecting agents (chlorine, an ultraviolet to radiation). Bacteria of the Klebsiella strain have high penetration in the water-bearing horizons. At strains of Klebsiella there is allocated considerable pathogenic potential (adhesive, invasive, phosphatase, lecithinase, DNA-ase, hemolytic activity) and genetic markers of pathogenicity of cnf-1. The etiologic role of bacteria of Klebsiella and an infecting (100, COE/dm3) dose emergence of acute intestinal infections (AII) is established. Detection of Klebsiella in water objects and especially in water of drinking appointment, in the absence of total coliform bacteria (TCB) contributes to the epidemic danger of water use.