[Physical exercise in combined outpatient rehabilitation of patients with ischemic heart disease associated with biliary dysfunction].

AIM: To study prevalence of gastrointestinal symptoms (GIS) including gall-bladder dysfunction (GBD) in coronary patients after acute coronary event (ACE) and effects of early physical exercise (PE) of moderate intensity in coronary patients with GBD on efficacy of outpatient rehabilitation. MATERIAL AND METHODS: A two-stage trial was conducted. Stage 1: 237 coronary patients responded to questionnaire detecting incidence of GIS including GBD 8 weeks after ACE. Stage 2: 85 coronary patients with verified GBD were examined for efficacy of rehabilitation. Of them, 43 patients entered PE group while 42 patients entered a control group. The latter received standard therapy without PE. The efficacy of the treatment was evaluated by clinical, device and biochemical findings at baseline and 12 months later. RESULTS: Of 237 coronary patients 217 (91.7%) patients 2 months after ACE had symptoms of coronary insufficiency, 192 (81.3%) had GIS, 78.9% had GBD. Patients from PE group significantly improved exercise tolerance (bicycle exercise test reached 79.3 +/- 15 and 121.3 +/- 14.5 bt (p < 0.05), respectively. These patients demonstrated improvement of gall-bladder contraction, a decrease in the level of total cholesterol from 6.12 +/- 0.4 to 4.7 +/- 0.2 mmol/l (p < 0.05), of LDLP cholesterol from 3.85 +/- 0.21 to 2.86 +/- 0.32 mmol/l (p < 0.05), thioldisulphide coefficient from 13 +/- 0.3 to 2.7 +/- 0.4 (p < 0.01). The intergroup analysis 12 months after the study revealed significant differences in favor of the PE group. A weekly number of anginal attacks reduced from 5.1 +/- 1.5 to 1.3 +/- 1.4 (p < 0.01). CONCLUSION: The exercise program is rather effective and can be practiced outpatiently in coronary patients after ACE associated with GBD. It can be also used for secondary prophylaxis of cholestasis in coronary patients with biliary problems.

[Current rabies epizootiology]. / Sovremennaia épizootologiia beshenstva.

Situation in rabies in the Russian Federation (RF) remains to be tense and is characterized by important specific features. Central Russia and the Moscow region have essential differences in the epizootic situation, the epizootological structure of rabies and other indices as compared with the Russian Federation. In the course of the last 25 years the ecological stereotype of rabies has undergone considerable transformations, becoming natural focal infection with the circulation of the infective agent among wild carnivores, which is now particularly obvious in the Moscow region. In 1998 a sharp rise in rabies morbidity occurred in Central Russia: peak values exceeded average annual values 2 times for the RF, 4 times for Central Russia and more than 10 times for the Moscow region. The situation in rabies in the Moscow region permits to use it as a model in the study of today rabies.

[Frequency dynamics of foxes as a factor of epizootic risk of rabies]. / Dinamika chislennosti lisitsy kak faktor épizootologicheskogo riska beshenstva.

During the period preceding the year 1998 when the peak values of the rabies incidence were registered in the Moscow region, a noticeable increase in fox frequency and the density of their population occurred, especially in 3 endemic areas of the north-western zone. Considering the fact that this zone was endemic for rabies, an increased density of the fox population was, most probably, the critical factor of the epizootological risk and the main cause of the emergency situation in rabies in 1998. The data obtained in this investigation may serve as a real basis for the prediction of the epizootic situation.

[Epizootic characteristic of rabies today]. / Epizootologicheskaia charakteristika sovremennogo beshenstva.

During the 23 year period rabies was registered in the Moscow region in 163 cases among foxes, 22 cases among racoon-like dogs, 92 cases among dogs, 54 cases among cats. In 1991-2000 ten cases of rabies were registered among other wild animal other than foxes and raccoon-like dogs (hares, hedge-hogs, polecats, badgers, hamsters, martens, rats). Under today conditions the generalized epizootological pattern of rabies is characterized by the vector "natural foci-->anthropurgic foci" with wild and domestic animals playing an alternative role in the epizootic process and the circulation of the infective agent. Wild carnivorous animals maintain natural focal infection in time and space, while all domestic animals are a direct or indirect ecological impasse and took no part in the maintenance of the infection. Foxes are the main source of infection for the animals of the anthropurgic cycle: they play a special role in the development of the epizootic situation in the region as the main reservoir and source of the causative agent of rabies as a natural focal infection. Among other wild animals, raccoon-like dogs are involved into epizootic and epidemic chains. Dogs are the main objects to be infected in the anthropurgic cycles, while cats--a progressing group of risk. During the period of 25 years a decrease in the probability of natural rabies was noted.

[The epidemiology and epizootiology of rabies on the territory of the former USSR]. / Epidemiologiia i épizootologiia beshchenstva na territorii byvshego SSSR.

On the territory of the former USSR rabies is as infection with natural foci in the western and central regions. In the republics of Central Asia and Transcaucasia, in the North Caucasus the presence of natural foci of infection is combined with appearance of the foci of rabies, mainly among dogs, due to human activities. The existence of natural epizootic cycles of three years has been established, and the natural foci of rabies have been found to prevail in certain landscape zones: steppes, forest-steppes, tundra, forest tundra. A vast zone of northern taiga remained free from this disease. About half a million persons asked for medical assistance in connection with rabies annually, and about 50% of them received urgent antirabies treatment. Of the total number of persons asking for antirabies assistance, the proportion of rural dwellers was about 30%, while the majority of rabies patients were from rural areas (about 70%). During the period under study the incidence of this disease among humans did not show any tendency towards a decrease and constituted 0.01-0.02 cases per 1,000 persons. Of the total number of persons contacting this disease, only 30% went to a clinic for medical assistance.