ХРОНИЧЕСКИЕ ВИРУСНЫЕ ГЕПАТИТЫ, ТУБЕРКУЛЕЗ И ВИЧ-ИНФЕКЦИЯ КАК СОЧЕТАННЫЕ ЗАБОЛЕВАНИЯ: ОТ ТЕОРИИ К ПРАКТИКЕ

With the aim of improving the system of epidemiological surveillance and monitoring of the most significant and socially determined co-infections, carried out the epidemiological analysis of viral hepatitis B and C, tuberculosis and HIV infection who were registered in the Clinical infectious hospital named. S. P. Botkin in the beginning of this century (17-year period). Examined 707 patients. The comparison carried out between the three groups of patients co-infected identified in 1998–2001 year (period I, 128 patients), 2008– 2011 year (period II, 334 patients) and in 2013–2014 (period III, 245 patients). The proportion of patients with acute viral hepatitis in the first period was 24.2%, and the second and third periods, their share declined to 0,6% and 0,4%. Among the chronic viral hepatitis in the first and second periods were dominated by chronic viral hepatitis C (of 28,1 and 39,8%), and in the third period came to dominate the hepatitis caused by combination viruses B and C (58,8 per cent). Symptoms of liver damage and the activity of enzymes in patients co-infected testified to the increase in the number of cases of cirrhosis of this body and served morphological studies, the prevalence of liver cirrhosis increased more than 4 times, from 8,6% (first period) to 26,9% (period III). Changes of tuberculosis, showed a significant increase in the share of common forms of tuberculosis, including disseminated tuberculosis of the lungs from 19,5% to 57,6% (3 times), and lymph system, including tuberculosis of lymphatic nodes of the chest from 3,1% (period I) to 27,8% (period II). The main changes in patients with co-infection was associated with HIV, whose share increased from 10,0% of (period I) to 91,8% (period III). The mortality of patients co-infected increased from 11,7 to 34,7% (3 times).С целью совершенствования системы эпидемиологического надзора и мониторинга наиболее значимых и социально обусловленных сочетанных инфекций проведен эпидемиологический анализ хронических вирусных гепатитов В и С, туберкулеза и ВИЧ-инфекции, которые были зарегистрированы в Клинической инфекционной больнице им. С.П. Боткина в начале текущего столетия (17-летний период). Обследовано 707 больных. Сравнение проведено между тремя группами больных сочетанной инфекцией, выявленных в 1998–2001 гг. (I период, 128 больных), в 2008–2011 гг. (II период, 334 больных) и в 2013–2014 гг. (III период, 245 больных). Доля больных с острыми вирусными гепатитами в первый период составила 24,2%, а во второй и третий периоды их доля снизилась до 0,6% и 0,4%. Среди хронических вирусных гепатитов в первом и втором периодах наблюдения преобладал хронический вирусный гепатит С (28,1 и 39,8%), а в третьем периоде стал доминировать гепатит, вызванный комбинацией вирусов В и С (58,8%). Симптомы поражения печени и активность цитолитических ферментов у больных сочетанной инфекцией свидетельствовали о нарастании числа случаев цирроза этого органа, а по данным морфологических исследований, доля лиц с циррозами печени увеличилась более чем в 4 раза: с 8,6% (I период) до 26,9% (III период). Изменения, касающиеся туберкулеза, характеризовались значительным увеличением доли распространенных форм туберкулеза, включая диссеминированный туберкулез легких с 19,5% до 57,6% (в 3 раза), и поражением лимфатической системы, в том числе и туберкулез внутригрудных лимфатических узлов с 3,1% (I период) до 27,8% (II период). Основные изменения у больных сочетанной инфекцией были ассоциированы с ВИЧ, удельный вес которых увеличился с 10,0% (I период) до 91,8% (III период). Летальность больных сочетанной инфекцией возросла с 11,7 до 34,7% (в 3 раза)

ХАРАКТЕРИСТИКА ЛЕТАЛЬНОСТИ КАК ПОКАЗАТЕЛЯ СОЦИАЛЬНОЙ ЗНАЧИМОСТИ СОЧЕТАННЫХ ИНФЕКЦИЙ

The Combined Socially Important Infections (CSII) in St. Petersburg are result of accumulation of chroniogenic potential of HIV infection, tuberculosis and chronic viral hepatitis B and C. The analysis of a lethality from the combined infection (CI) for the long-term period in dynamics by years, showed to age and sexual groups and other signs that it exceeds that from tuberculosis by 2,4 times, from chronic hepatitis by 7,5 times. High level of a lethality of persons of young age, sharp growth of tuberculosis of intra chest, intra belly lymph nodes, frequent generalization of process with involvement in process of a liver, a spleen, kidneys testifies to the leading role of HIV infection in failures of diseases. The system and algorithm of proofs about the reasons of lethal outcomes of SI have to be based on representative selections. For this purpose it is necessary to carry out registration of HIV infection not only in the AIDS centers, but also regional in the form of the uniform register SI (HIV+TB+HIC or HIB) for the purpose of complex impact on epidemic process.Увеличение заболеваемости сочетанными социально-значимыми инфекциями (ССЗИ) в Санкт-Петербурге связано с накоплением хрониогенного потенциала ВИЧ-инфекции, туберкулеза и хронических вирусных гепатитов В и С в предыдущий период времени. Анализ летальности от сочетанной инфекции (СИ) за многолетний период в динамике по годам, возрастно-половым группам и другим признакам показал, что она превышает таковую от туберкулеза в 2,4 раза, от хронических гепатитов – в 7,5 раза. Высокий уровень летальности лиц молодого возраста, резкий рост доли туберкулеза внутригрудных, внутрибрюшных лимфатических узлов, частая генерализация процесса с вовлечением печени, селезенки, почек свидетельствует о ведущей роли ВИЧ-инфекции в неблагоприятных исходах заболеваний. Система и алгоритм доказательств о причинах летальных исходов СИ должны основываться на репрезентативных выборках. Для этого необходимо осуществлять регистрацию ВИЧ-инфекции не только в центрах СПИД, но и регионально в виде единого регистра СИ (ВИЧ+туберкулез+вирусные гепатиты) с целью комплексного воздействия на эпидемический процесс

Neighborhood Characteristics And Prescription Drug Misuse Among Adolescents: The Importance Of Social Disorganization And Social Capital

Background Prior research on prescription drug misuse has focused on identifying individual risk factors. While a few studies examine differences in misuse based on geographic residence, there is a lack of research that examines the relevance of neighbourhood characteristics. Methods The current research used data from the 2000 National Household Survey on Drug Abuse, a sample of respondents that was generalizable to the non-institutionalised population of the United States. Logistic regression models were estimated to examine the relationship between neighbourhood characteristics (e.g., social disorganisation, social capital, and social participation) and prescription drug misuse (e.g., any misuse, pain reliever misuse, sedative/tranquiliser misuse, and stimulant misuse) among adolescent respondents ages 12–17. Results Findings show that neighbourhood characteristics were significantly associated with any prescription drug misuse and also the misuse of prescription opioids. Adolescents in socially disorganised neighbourhoods and also those in neighbourhoods with lower levels of social capital were more likely to report prescription drug misuse. Interestingly, adolescents with greater levels of social participation were more likely to report prescription drug misuse. Conclusion These findings were largely consistent with prior research examining the significance of neighbourhood characteristics in relation to crime and deviance. In order to adequately address the ongoing prescription drug epidemic in the United States, policy makers must address the neighbourhood characteristics that are known to be associated with prescription drug misuse

CHRONIC VIRAL HEPATITIS, TUBERCULOSIS, AND HIV AS COMORBIDITY: FROM THEORY TO PRACTICE

With the aim of improving the system of epidemiological surveillance and monitoring of the most significant and socially determined co-infections, carried out the epidemiological analysis of viral hepatitis B and C, tuberculosis and HIV infection who were registered in the Clinical infectious hospital named. S. P. Botkin in the beginning of this century (17-year period). Examined 707 patients. The comparison carried out between the three groups of patients co-infected identified in 1998–2001 year (period I, 128 patients), 2008– 2011 year (period II, 334 patients) and in 2013–2014 (period III, 245 patients). The proportion of patients with acute viral hepatitis in the first period was 24.2%, and the second and third periods, their share declined to 0,6% and 0,4%. Among the chronic viral hepatitis in the first and second periods were dominated by chronic viral hepatitis C (of 28,1 and 39,8%), and in the third period came to dominate the hepatitis caused by combination viruses B and C (58,8 per cent). Symptoms of liver damage and the activity of enzymes in patients co-infected testified to the increase in the number of cases of cirrhosis of this body and served morphological studies, the prevalence of liver cirrhosis increased more than 4 times, from 8,6% (first period) to 26,9% (period III). Changes of tuberculosis, showed a significant increase in the share of common forms of tuberculosis, including disseminated tuberculosis of the lungs from 19,5% to 57,6% (3 times), and lymph system, including tuberculosis of lymphatic nodes of the chest from 3,1% (period I) to 27,8% (period II). The main changes in patients with co-infection was associated with HIV, whose share increased from 10,0% of (period I) to 91,8% (period III). The mortality of patients co-infected increased from 11,7 to 34,7% (3 times)

Ornamenta sacra. Des objets comme ornements aux ornements des objets

Cette communication ambitionne d’interroger l’intitulé même des objets liturgiques : les ornamenta sacra. Si ces objets reçoivent, depuis le Moyen Âge, le nom d’« ornements sacrés », c’est que le terme d’ornement a alors un double sens : celui d’équipement, servant au bon fonctionnement d’une chose, et celui d’embellissement renvoyant à l’univers de la parure, une double acception qui met en lumière la double fonction – utilitaire et esthétique – inhérente à l’ensemble des objets liturgiques. Il s’agira ici d’envisager l’articulation entre ces deux polarités tout en accordant une attention particulière au décor de ces objets, décor qui oscille lui-même entre image et ornement. L’ornement des objets tend en effet à prendre une importance croissante dès le XVIIe siècle, au détriment même de l’image qui se dilue dans un foisonnement ornemental, un phénomène qui est à situer à un moment où le statut de ces objets, comme celui de l’ornement et de l’image, est en pleine mutation

ECG-gated CT angiography of the thoracic aorta: the importance of evaluating the coronary arteries

Aim: To evaluate the feasibility of coronary artery disease (CAD) evaluation using electrocardiogram-gated computed tomography CT of the thoracic aorta. Materials and methods: A total of 477 patients, who underwent CT angiography of the thoracic aorta, were included retrospectively. Dose\u2013length products (DLP) were recorded. Two blinded readers graded image quality of the coronary arteries on a three-point scale. Coronary artery stenosis has only been reported if considered significant, i.e., 6550%. The type of plaque responsible for the stenosis was considered. The normal distribution of the data was assessed using Shapiro\u2013Wilk and Anderson\u2013Darling tests. Results were expressed as means and standard deviations and percentages. Inter-reader agreements were analysed by calculating the intraclass correlation coefficient, and by using Cohen kappa statistics. Results: The mean DLP was 566\ub190.4 mGy 19cm, corresponding to an effective dose of 9.6\ub11.5 mSv. Five point three percent of asymptomatic patients were positive for CAD with stenosis 6550%. All patients with coronary stenosis presented with a soft plaque. Two anomalous coronary origins were found. The inter-reader agreement was excellent in defining both the quality of the examination and the degree of coronary stenosis (k=0.85). Conclusion: The opportunity to prove the presence of CAD in asymptomatic patients during a ECG-gated CT of the thoracic aorta can have an extremely important clinical impact, promoting the best therapeutic pathway for the patient. Therefore, coronary arteries should always be analysed carefully and reported in ECG-gated CT angiography of the thoracic aorta

The characteristic of lethality as an indicator of combinad infections

The Combined Socially Important Infections (CSII) in St. Petersburg are result of accumulation of chroniogenic potential of HIV infection, tuberculosis and chronic viral hepatitis B and C. The analysis of a lethality from the combined infection (CI) for the long-term period in dynamics by years, showed to age and sexual groups and other signs that it exceeds that from tuberculosis by 2,4 times, from chronic hepatitis by 7,5 times. High level of a lethality of persons of young age, sharp growth of tuberculosis of intra chest, intra belly lymph nodes, frequent generalization of process with involvement in process of a liver, a spleen, kidneys testifies to the leading role of HIV infection in failures of diseases. The system and algorithm of proofs about the reasons of lethal outcomes of SI have to be based on representative selections. For this purpose it is necessary to carry out registration of HIV infection not only in the AIDS centers, but also regional in the form of the uniform register SI (HIV+TB+HIC or HIB) for the purpose of complex impact on epidemic process