['Masks' of acute neuroinfections and markers of differencial diagnosis]. / 'Maski' ostrykh neiroinfektsii i markery differentsial'noi diagnostiki.

AIM: To compare thе medical history, clinical features, composition of cerebrospinal fluid (CSF), results of laboratory and instrumental examinations of patients with acute neuroinfections and differentiable diseases including a pseudoinflammatory variant of the acute stage of uncomplicated subarachnoid hemorrhage (SAH), consequences of traumatic brain injury (traumatic SAH, SAN combination with secondary purulent meningitis, posttraumatic nasal liquorrhea, intracerebral hematomas), abscesses and tumors of the brain, lymphoma with proven CNS. These diagnoses were mistakenly made to patients admitted to an infectious department. MATERIAL AND METHODS: Forty-six patients, aged from 18 to 83 years, hospitalized in the Department of neuroinfections and intensive care in 2010-2016 were examined. Conventional clinical neurological, laboratory, instrumental (including MRI) examinations of patients, comprehensive examination of CSF samples, the study of markers of inflammation (C - reactive protein, CSF lactate), immunophenotyping of CSF cells were performed. RESULTS AND CONCLUSION: The misdiagnosis can be explained by the overestimation of such symptoms as the acute (in most cases) onset of the disease with increased body temperature to febrile levels, presence of meningeal syndrome, disorders of consciousness and focal symptoms of varying severity. The authors showed the errors and difficulties in the diagnosis, the role and importance of an integrated, interdisciplinary approach taking into account history, clinical data, results of CSF study, conventional and special methods of laboratory and instrumental examination of patients.

[Correlation between the receptor specificity of pandemic influenza A (H1N1)pdm09 virus strains isolated in 2009-2011 and the structure of the receptor-binding site and the probability of fatal primary viral pneumonia].

The receptor specificity (RS) of pandemic influenza A(H1N1) pdm09 virus strains deposited into the State Collection of Viruses of the Russian Federation, D. I. Ivanovsky Research Institute of Virology, Ministry of Health and Social Development of Russia, in the 2009-2010 and 2010-2011 epidemic seasons to a panel of 9 sialoglycopolymers (SGP). The strains were divided into 3 groups according to the W(3/6) index proposed by the authors, which was equal to the amount of reactivities to unbranched alpha2-3-SGP to that of reactivities to unbranched alphal-6-SGP: W(3/6) < or = 1.0; 1.0 < W(3/6) < or = 1.5. The W(3/6) < or = 1.5 group showed a predominance of a2-3-RS, attended by the high incidence of fatal primary viral pneumonias (FPVP) (60.0%) and amino acid replacements in the HA1 receptor-binding site (RBS) (80.0%): D222{G, N} and Q223R. The 1.0 < W(3/6) < or = 1.5 group was characterized by mixed alpha2-3/alpha2-6-RS with the incidence of FPVP (29.7%) and amino acid replacements in the HA1 RBS (40.5%) (D222{G, N, V} and Q223), respectively. In the W(3/6) < or = 1.0 group, alpha2-6-RS was prevalent, FPVPs were absent and amino acid replacements in HA1 RBS (D222{G, E}) were seen only in 6.0% of cases. The number of strains with increased specificity to alpha2-3-sialosides increased in the 2010-2011 epidemic season as compared to the previous season. With their further spread among the population, there may be a rise in cases of severe primary viral pneumonias with possible fatal outcomes, which can be, however, accompanied by a decrease in the capacity of mutants to air-dropwise transmission.

[The specific features of the cocirculation of influenza viruses in the 2010-2011 postpandemic period according to the results of activities of the D. I. Ivanovsky Research Institute of Virology, Ministry of Health and Social Development of Russia].

The paper gives the results of monitoring the circulation of influenza viruses in the 2010-2011 season, that covers the second year of circulation of pandemic A(H1N1)v virus strains, and their interaction with seasonal A (H3N2) and B strains. Unlike the previous season, the beginning of an increase in morbidity was recorded in January 2011; its peak in the most of contiguous areas was noted at 5-7 weeks of 2011, with its further decline to threshold levels at week 11 of 2011. Preschool and school children were most involved in the epidemic process. Three influenza virus strains (A(H1N1)v, A(H3N2), and B) were found to circulate. Differences were found in the level of participation of the isolated strains in individual areas of the Russian Federation. Detailed typing of the isolated strains determined the compliance of the vast majority of them with vaccine viruses. The pandemic influenza A(H1N1)v virus strains retained their susceptibility to oseltamivir and were resistant to rimantadine. The participation of non-influenza acute respiratory viral infection pathogens was estimated as follows: 11.9% for parainfluenza viruses, 5.9% for adenoviruses, and 3.5% for PC viruses, and 0.7% for pneumonia Mycoplasma, which was comparable with the previous epidemic seasons.

[Comparative analysis of methods for laboratory diagnosis of Lyme's disease in early stages of infection]. / Sravnitel'nyi analiz metodov laboratornoi diagnostiki bolezni laima na rannei stadii infektsii.

Different methods of laboratory diagnostics were comparatively analyzed in examining 25 patients at the early infection stage. Sera were measured by using various serological reactions. Specific antibodies were determined by using the reaction of indirect immune-fluorescence (RIIF), the immune-enzyme analysis (IEA) and the complement-binding reaction (CBR) in 83.1%, 54.4% and 12.5% of cases, respectively. Essential differences in sensitivity were detected between the above methods. RIIF was proven to be a reliable and sufficiently sensitive method in the laboratory diagnostics of Lyma's disease. While the use of two methods, i.e. RIIF and IEA, ensures the highest percentage of detection of antibodies to the causative agent of Lyma's disease.

[Bacterial endotoxinemia in children with intestinal dysbacteriosis]. / Bakterial'naia éndotoksinemiia u detei s disbiozom kishechnika.

34 children with gastrointestinal diseases of infectious, allergic and mixed etiology were examined. The state of normal microflora in the large intestine as indicated by fecal bacterial charts and the level of secretory immunoglobulin A (sIgA) in the contents of the intestine as indicated by the results of radial immunodiffusion were studied. In addition, the content of endotoxin in the children's plasma was determined with the use of the Limulus (LAL) test. The presence of endotoxin in the plasma of children with intestinal dysbiosis was determined in 71.1% of cases. The frequency of the detection of antigenemia was found to be related to the severity of manifestations of dysbiotic changes in the intestine and to the level of sIgA in fecal supernatants. The inclusion of the probiotic preparation Bifidumbacterin forte containing live bifidobacteria adsorbed on activated charcoal into the complex therapy of digestive tract diseases ensured a decrease in the detection rate of endotoxinemia, which correlated with the tendency towards the normalization of defective intestinal microflora.

[The results of a multicenter study of the comparative activity of cefepime and other antibiotics against the causative agents of severe hospital infections (the Micromax program)]. / Rezul'taty mnogotsentrovogo issledovaniia sravnitel'noi aktivnosti tsefepima i drugikh antibiotikov v otnoshenii vozbuditelei tiazhelykh gospital'nykh infektsii (programma "Micromax").

A multicentre trial was performed on the activity of cefepime in comparison with ceftazidime, ceftriaxone, piperacillin/tazobactam, imipenem and ciprofloxacin against severe hospital infection pathogens in intensive care units. The isolates of Escherichia coli and Proteus spp. from the majority of the centres were highly susceptible to the antibiotics (90 to 100 per cent of the isolates). In some centres up to 40 per cent of the isolates produced ESBL. The isolates of Klebsiella spp. were characterized by lower susceptibility, in some centres the frequency of the strains producing ESBL exceeded 90 per cent, by the MIC geometric mean cefepime was superior to the third generation cephalosporins, the frequency of resistance to ciprofloxacin ranged from 0 to 31 per cent, no resistance to imipenem was recorded. The frequency of resistance to the third generation cephalosporins and piperacillin/tazobactam in Enterobacter spp., Serratia spp., Citrobacter spp., Morganella spp., and Providencia spp. ranged from 10 to 52 per cent, the resistance to cefepime equaled 0-11 per cent, 0 to 17 per cent of the isolates were resistant to ciprofloxacin, some isolates were resistant to imipenem. As for the nonfermenting microorganisms their resistance to all the antibiotics tested was comparatively high and markedly differed in various centres. As a whole, 7 per cent of all the isolates of the nonfermenting organisms was resistant to cefepime, 10 per cent was resistant to imipenem, 17 per cent was resistant to ceftazidime, 21 per cent was resistant to piperacillin/tazobactam and 36 per cent was resistant to ciprofloxacin.

[Rehabilitation of patients with ischemic heart disease after aortocoronary bypass surgery]. / Reabilitatsiia bol'nykh ishemicheskoi bolezn'iu serdtsa posle operatsii aortokoronarnogo shuntirovaniia.

The paper outlines some experience in rehabilitating 1250 patients with coronary heart disease (CHD) undergone aortocoronary bypass surgery (ACBS). Rehabilitative measures promoted more rapid and maximally full recovery of physical fitness and cardiorespiratory parameters. The recommended groups of physical activity allow one to differentially approach to the choice of the optimum training regimen and hence to achieve the maximum training effect. The groundlessly high proportion of disabled patients with CHD after ACBS is due not to the quality of surgical treatment, but to the absence of a rehabilitative programme for this group of patients and to the presence of obsolete standard acts for definitions of disability groups by the medical-and-labor examination commission.

[Dirithromycin in the treatment of infections of the lower respiratory tract]. / Diritromitsin v lechenii infektsii nizhnikh dykhatel'nykh putei.

Good results of the treatment of patients with lower respiratory tract infections with dirithromycin (Eli Lilly, USA), a new semisynthetic macrolide, were recorded. The trial included 15 patients: 6 with acute bronchitis (AB) and 9 with exacerbation of chronic bronchitis (AB) and 9 with exacerbation of chronic bronchitis (ECB). The antibiotic was administered orally in a single dose of 500 mg once a day for 7 days. The treatment efficacy was estimated by the clinical results and laboratory findings. The sputum specimens were investigated bacteriologically with testing the microflora for the drug susceptibility by using the diffusion disks. 50 per cent of the patients with AB isolated Streptococcus viridans with low (the diameter of the growth inhibition zones < 16 mm) and intermediate (16-17 mm) susceptibility to the antibiotic, 33.3 per cent of the patients isolated highly susceptible (19 mm) strains of Str. pneumonia and 16.7 per cent of the patients isolated resistant (15 mm) strains of Staphylococcus epidermidis. Highly susceptible (17-19 mm) strains of Haemophilus influenzae and Str. viridans were isolated respectively from 55.5 and 45.5 per cent of the patients with ECB. In 4 patients with ECB a clinical improvement of the state was recorded. In the other patients with AB and ECB the recovery was stated. The bacteriological tests revealed a new pathogen in 2 patients with ECB and the failure of the treatment in another 2 patients with ECB. In all the other patients the pathogen was shown to be eradicated. In the patients isolating the new pathogen the symptomatic recovery was stated in the posttherapeutic period. Therefore, diritromycin proved to be efficient in 13 out of the 15 patients with lower respiratory tract infections. It should be noted that the drug tolerance was excellent. None of the patients showed any adverse reactions.

[Use of beta blockaders in patients with ischemic heart disease during in-hospital rehabilitation after aortocoronary bypass surgery]. / Primenenie beta-blokatorov u bol'nykh ishemicheskoi bolezn'iu serdtsa posle operatsii aortokoronarnogo shuntirovaniia na statsionarnom étape reabilitatsii.

After studying central hemodynamics in patients with ischemic heart disease who had undergone aortocoronary shunting without postoperative complications and angina pectoris, the authors came to the conclusion on the beneficial effect of small-dose beta-blockers in the above cases if they developed sinus tachycardia. Beta-blockers help reduce oxygen demand of the myocardium and make more effective cardiac performance.

[Immunobiological characteristics of Brucella outer membrane proteins, genetic determinants of which are expressed in Escherichia coli cells]. / Immunobiologicheskaia kharakteristika belkov naruzhnoi membrany brutsell, geneticheskie determinanty kotorykh ékspressiruiutsia v kletkakh Escherichia coli.

The influence of the brucella OMP preparations obtained by the genetic engineering technique (18, 38 and 18 + 38 kD) on the formation of the specific protection and progress of infectious process in brucellosis in the in vivo experiments has been studied. The OMPs synthesized in Escherichia coli cells GSE579 and having mol mass 18 and 38 kD are common antigens for a number of brucella species. The 18 kD OMP was found to protect 66.7% of experimental animals against brucellosis, while the protection by the commercial live vaccine was 78.0%. The 38 kD OMP did not possess the protective activity with the index of infectivity in the experimental group of animals being higher than the one in the control group (77.9% and 53.4% respectively). The indexes of colony forming units in the mice spleen were also higher in the experimental group of animals. The obtained results suggest that the 38 kD OMP may be a factor of brucella virulence.

[Sensitizing properties of Brucella protein antigens synthesized in K12 Escherichia coli cells]. / Sensibiliziruiushchie svoistva belkovykh antigenov brutsell, sintezirovannykh v kletkakh Escherichia coli K12.

The sensitizing properties of brucella 31 kD and 31+15 kD protein antigens produced by Escherichia coli cell carrying and expressing the corresponding brucella genes were compared. In experiments evaluating the test of mouse feet oedema in CBA line animals the property of the 31 kD antigen preparation to induce the specific oedema effect was demonstrated on the level comparable with the one produced by the brucella outer membrane proteins preparation. The obtained data were confirmed in the experiments on adoptive transfer of prolonged type hypersensitivity via the spleen cells from the sensitized donors to intact recipient animals. The future of molecular cloning technique usage for obtaining the homogeneous stable preparations of brucella antigens with low reactivity and high specificity is discussed.

[Clinical and social factors of resuming work by patients with ischemic heart disease after aortocoronary bypass]. / Klinicheskie i sotsial'nye faktory vozvrashcheniia k trudu bol'nykh ishemicheskoi bolezn'iu serdtsa posle operatsii aortokoronarnogo shuntirovaniia.

In spite of the fact that clinical condition in 85.6% of coronary patients subjected to aortocoronary shunting has improved against their preoperative status, only 43.3% of them resume work. Invalidity in these patients increases two-fold mounting to 94.4%. The causes of the discrepancy between the expected and real performance are scrutinized with due consideration of clinical and social factors essential for the patients' decision to resume or give up work.

[Work capacity of patients with ischemic heart disease after aortocoronary bypass]. / Trudosposobnost' bol'nykh ishemicheskoi bolezn'iu serdtsa posle operatsii aortokoronarnogo shuntirovaniia.

A comparison was made of the clinicofunctional efficiency and social significance of surgical therapy techniques in patients with coronary heart disease (CHD). One hundred and seventy eight patients aged 25 to 59 years who had been operated on in the A. N. Bakulev Institute of Cardiovascular Surgery from 1984 to 1987 were examined. In prolonged periods (mean 2.8 +/- 0.2 years) following surgeries, 85.6% of the patients showed clinical improvement as compared to the preoperative period. At the same time, a total of 43.3% of the patients returned to work, the figure being much less than that observed in the preoperative period. (78.1%). Following the surgery, there was a high rate (94.4%) of disability. Two groups of factors were defined, which determined the patients' return to work after coronary aorta bypass grafting. The low work resumption and high disability rates after surgery are due to the lack of a national social rehabilitation programme for this group of patients.

[Immunochemical characteristics and serologic properties of lipopolysaccharides isolated from various Brucella species using various extraction methods]. / Immunokhimicheskaia kharakteristika i serologicheskie svoistva lipopolisakharidov, vydelennykh iz raznykh vidov brutsell razlichnymi metodami ékstraktsii.

The results of the comparative analysis of LPS isolated by different methods of extraction from the cultures of several Brucella species differing in their virulence are presented. Purified LPS preparations have been obtained from Brucella virulent and vaccine strains by using such methods as water-phenol extraction, Boivin's method, mild alkaline hydrolysis of the antigen according to Boivin's procedure. The presence of certain relationship between the method used for the extraction of Brucella LPS to be compared and their chemical composition, immunological characteristics and serological activity has been established. As shown in this investigation, in the process of the preparation of a highly sensitive diagnosticum for the passive hemagglutination test the use of LPS obtained from Brucella virulent strains, but not from the vaccine strain, by the method of mild alkaline hydrolysis according to Boivin's procedure is expedient. The data presented in this work indicate that the soluble complex of lipid A obtained from Brucella LPS has been found to possess serological activity. The results of the study of the serological properties of lipid A indicate that the lipid component may also play a certain role in the manifestation of the serological activity of Brucella LPS.

[Effect of gamma irradiation on the immunological properties of the brucellar protective antigen]. / Vliianie gamma-oblucheniia na immunologicheskie svoistva brutselleznogo protektivnogo antigena.

It was shown that the splenocytic response to mitogens in guinea pigs was activated 7 days following immunization thereof with a gamma-irradiated brucellar protective agent (gamma-BPA), while nonirradiated BPA inhibited lymphocyte proliferation under the effect of mitogens. gamma-BPA, as compared with BPA, circulated in blood for a longer time, induced a more rapid and prolonged synthesis of antibodies, and provided the development of a more intensive immunity.