Experience in Building Infectious Hospital for Treatment of Particularly Dangerous Infectious Diseases in the Republic of Guinea

Ebola treatment hospital was constructed within the frames of the West Africa support infinitive of the Russian Federation, in cooperation with the United Company “RUSAL”. Permanent building with bed capacity rated 60 and strict separation of clean area from hazard zone set this medical facility apart from tent camps, which are used by international organizations. For the first time ever, in West Africa, deployed was a strategy of waste decontamination using caustic. It is of note that due to biological safety procedure compliance, no case of nosocomial infection was registered during the whole time of operation. Commissioning of this hospital is an effective mechanism for Ebola virus disease control

Epidemiological Peculiarities and Clinical Features of Ebola Virus Disease in the Republic of Guinea

The current outbreak of the Ebola fever in West Africa is unprecedented in terms of its scale. As of today, 27550 suspected cases and 11235 deaths have been reported. The outbreak differs from previous epidemics in terms of epidemiological and clinical progression of the disease. The article covers several epidemiological issues related to Ebola virus disease by the example of the Guinean outbreak, which has been plaguing the country since 2014. Given is the preliminary clinical analysis of the medical observations, performed in the Research and Diagnostic Centre of Epidemiology and Microbiology built by RUSAL. Regarded are epidemiological and clinical features of the Ebola virus disease (EVD) in 83 patients, who were admitted to RUSAL Treatment Center since March 6th till June 30th, 2015. In 28 of the patients, EVD diagnosis was laboratory confirmed. The principle assessment criteria are: morbidity rate, lethality index, gender, age, occupation, time since the onset of the disease until hospitalization, an average duration of the stay at the hospital, complaints, symptoms, complications, and the therapy provided

Анализ факторов риска и эффективности Дефибротида для лечения синдрома обструкции синусоидов/веноокклюзионной болезни печени после аллогенной трансплантации гемопоэтических стволовых клеток у детей и взрослых

Introduction. Sinusoidal obstructive syndrome (SOS)/veno-occlusive liver disease (VOD) is one of the most dangerous complication of allogeneic hematopoietic stem cell transplantation (alloHSCT).The objective of our study was to analyze risk factors associated with SOS/VOD in children and adults after alloHSCT.Methods and materials. The study included 76 patients who were diagnosed with the development of SOS/VOD after alloHSCT performed in Raisa Gorbacheva Memorial Research Institute for Pediatric Oncology, Hematology and Transplantation between 2001 and 2019. 25 patients (32.9 %) were younger than 18 years, 51 patients (68.1 %) — 18 years and older. Among them, 17 patients were treated with defibrotide at a dose of 25 mg/kg per day, median therapy duration — 21 day.Results. One-year overall survival (OS) was significantly higher when partial and complete response to the therapy was achieved — 45 %, than when there was no response — 0 % in the general group (p = 0.001). According to the results of multivariate analysis of unrelated alloHSCT HR 2.040 (95 %CI 1.112-3.744, р = 0.021), acute GVHD HR 0.496 (95 % CI 0.272-0.903, р = 0.022), moderate/severe SOS/VOD HR 2.423 (95 % CI 1.298-4.524, p = 0.005) statistically significantly influenced the 1-year OS. Defibrotide and accompanying therapy did not significantly influence the 1-year OS in children and adults (n=76) - 53 % and 54 % (p=0.86), respectively. In a multivariate analysis. unrelated alloHSCT HR 8.172 (95 %CI 2.176-30.696, р=0.002) and moderate and severe SOS/VOD HR 9.077 (95 % CI 2.425-33.978, р=0.001) significantly influenced the 1-year OS in the pediatric group.Conclusion. The understanding of risk factors of adverse prognosis in patients SOS/VOD facilitates selection of patients who will benefit the most from therapy with defibrotide. Early administration of defibrotide in the course of VOD/SOS is crucial to achieve response.Введение. Синдром обструкции синусоидов (СОС)/веноокклюзионная болезнь печени (ВОБ) — одно из фатальных осложнений аллогенной трансплантации гемопоэтических стволовых клеток (аллоТГСК).Целью исследования является оценка факторов риска и эффективности применения Дефибротида при СОС/ ВОБ у детей и взрослых после аллоТГСК.Методы и материалы. В исследование включены 76 пациентов НИИДОГИТ им. Р. М. Горбачёвой после аллоТГСК, у которых в период с 2001 по 2019 г. было выявлено развитие СОС/ВОБ печени. В возрасте до 18 лет наблюдали 25 (32,9 %) пациентов, 51 (68,1 %) пациент — 18 лет и старше. Из них 17 пациентов получили Дефибротид в дозе 25 мг/кг в сутки, медиана длительности терапии составила 21 день.Результаты. Однолетняя общая выживаемость (ОВ) была значимо выше при достижении частичного и полного ответа на терапию — 45 %, чем при отсутствии ответа — 0 % в общей группе (р = 0,001). По результатам многофакторного анализа аллоТГСК от неродственного донора ОР 2,040 (95 % ДИ 1,112 — 3,744, р = 0,021), наличие острой реакции «трансплантат против хозяина» (оРТПХ) ОР 0,496 (95 % ДИ 0,272 — 0,903, р = 0,022), степень СОС/ВОБ ОР 2,423 (95 % ДИ 1,298 — 4,524, р = 0,005) статистически значимо влияли на 1-летнюю ОВ. При применении Дефибротида и сопроводительной терапии 1-летняя ОВ не различалась в группе взрослых и детей (n=76) и составила 53 и 54 % соответственно (Р = 0,86). В многофакторном анализе аллоТГСК от неродственного донора — ОР 8,172 (95 % ДИ 2,176 — 30,696, р = 0,002) и СОС/ВОБ 2 — 3-й степени — ОР 9,077 (95 % ДИ 2,425 — 33,978, р = 0,001) — статистически значимо влияли на 1-летнюю ОВ в педиатрической группе.Заключение. Обнаружение неблагоприятных факторов риска позволит сделать диагностику СОС/ВОБ более своевременной и безотлагательно начать терапию, что имеет ключевое значение для эффективного лечения данного осложнения аллоТГСК