ПОБУДОВА Й АНАЛІЗ МОДЕЛІ ПРИЙНЯТТЯ РІШЕНЬ ПРИ ОЦІНЦІ НАСЛІДКІВ ВАКЦИНАЦІЇ ПРОТИРОТАВІРУСНОЮ ВАКЦИНОЮ В УКРАЇНІ

The results of computational and theoretical studies related to assessing of efficiency indicators of immunization with rotavirus vaccine in Ukraine among children under five years are presented. The Indicators of the impact were received with computer implementation of decision tree model based on Markov processes. Under strategies of vaccination and no vaccination projected levels of morbidity, number of hospital admissions, mortality of rotavirus infection and other factors were received. It was shown that the vaccination with rotavirus vaccine will have significant medical significance in Ukraine.Представлены результаты расчетно-теоретических исследований, связанных с оценкой показателей эффективности вакцинопрофилактики противоротавирусной вакциной в Украине среди детей в возрасте до пяти лет. Показатели этого воздействия получены реализацией компьютерной модели дерева принятия решений на основе Марковских процессов. В рамках стратегий вакцинации и без вакцинации получены прогнозные показатели заболеваемости, количества госпитализаций, смертности при ротавирусной инфекции и другие показатели. Показано, что вакцинопрофилактика противоротавирусной вакциной будет иметь существенное медицинское значение в Украине.Представлені результати розрахунково-теоретичних досліджень, пов'язаних з оцінкою показників ефективності вакцинопрофілактики протиротавірусною вакциною в Україні серед дітей віком до п'яти років. Показники цього впливу отримані реалізацією комп'ютерної моделі дерева прийняття рішень на основі Марківських процесів. В рамках стратегій вакцинації і без вакцинації отримані прогнозні показники захворюваності, кількості госпіталізацій, смертності при ротавірусній інфекції та інші показники. Показано, що вакцинопрофілактика протиротавірусною вакциною матиме значне медичне значення в Україні

ЕТІОЛОГІЧНА ДІАГНОСТИКА ГОСТРИХ ВІРУСНИХ ІНФЕКЦІЙ: РОЛЬ У СУЧАСНІЙ СИСТЕМІ ОХОРОНИ ЗДОРОВ’Я ТА ЕКОНОМІЧНА ЕФЕКТИВНІСТЬ

The aim of the work – to determine the role of etiological diagnosis of acute viral infections in the modern health care system and methods for assessing its economic effectiveness.Results. Innovations of recent years in the etiological diagnosis of viral diseases, including molecular biological technologies, immuno-chromatographic analysis, biochips and others, have shown positive diagnostic and clinical results and are important for improvement into the health system. The main operational characteristics of laboratory tests are sensitivity, specificity, reproducibility, accuracy, quality control and performance time.Conclusions. Qualitative provision of medical care to patients with viral diseases can be achieved by focusing on the goals of the health care system to improve the quality and usefulness of medical care, including the etiological diagnosis of viral infections. Its result can also be used to predict the effectiveness of choosing alternative patient care tactics, as well as to monitor the effectiveness of treatment regimens and their correction.Мета роботи – визначити роль етіологічної діагностики гострих вірусних інфекцій в сучасній системі охорони здоров’я та методи оцінки її економічної ефективності.Результати. Інновації останніх років в етіологічній діагностиці вірусних захворювань, серед яких молекулярно-біологічні технології, технології на основі імунохроматографічного аналізу, використання біочипів та інші, показали позитивні діагностичні та клінічні результати та мають важливе значення для вдосконалення системи охорони здоров’я. Основними операційними характеристиками лабораторних тестів є чутливість, специфічність, відтворюваність, точність, контроль якості та час виконання.Висновки. Якісне надання медичної допомоги пацієнтам з вірусними захворюваннями може бути досягнуто, орієнтуючись на цілі системи охорони здоров’я для підвищення якості та корисності медичної допомоги, в тому числі етіологічної діагностики вірусних інфекцій

Analysis of antiviral use efficiency criteria in the complex pharmacotherapy of community acquired pneumonia

According to modern view, bacterial pathogens are the leading and most common cause of community-acquired pneumonia (CAP), but at the same time the results of numerous microbiological studies conducted in recent years showed that viruses confidently play the next leading role of CAP causes. Today, antiviral therapy is successfully used within the complex therapy of respiratory diseases, which allows reduction of the disease severity and minimizes the risk of complications. The main requirements for the antiviral drug are fully responsive to the new antiviral drug vitaglutam, the active component of which is pentanedioic acid imidazolyl ethanamide, is a low molecular weight compound, an analogue of the natural peptidoamine. The aim of the work. Mathematical modeling and analysis of clinical and laboratory indicators dynamics of CAP with additional antiviral pharmacotherapy based on pentanedioic acid imidazolyl ethanamide. In the study, it was used retrospective data of 106 patients with mild form of CAP of viral and bacterial etiology. Patients were randomly divided into two groups. In the 1st main group (50 patients), antibacterial therapy was combined with the antiviral drug vitaglutam. Analysis of antiviral therapy efficiency was provided by grouping of patients and determination of their distribution by gradations of clinical and laboratory indicators, as well as the construction of a mathematical model of their dynamics. According to modeling results, the rate of body temperature normalization, which was higher in patients taking vitaglutam, was a clear criterion for the efficiency of antiviral therapy. With additional antiviral therapy, the dynamics of sputum in the lungs was less intense. Positive clinical changes were accompanied by an improvement in the clinical blood analysis indicators, namely, more significant was the dynamics of ESR decrease. At the same time, dynamics of leukocytes number in patients’ blood was approximately the same in both groups. Analysis of dynamics of clinical and laboratory indicators using the proposed mathematical model suggests that additional prescription of vitaglutam to empirical stepwise antibiotic therapy can significantly reduce the time to achieve clinical and laboratory results of treatment of patients with CAP of viral and bacterial etiology

Bioinformation analysis of rotavirus vaccine efficiency

A couple of studies have shown that viruses cause from 25 to 60% of acute intestinal infections (AII) cases, among which rotaviruses play a leading role in the structure of children's AII of viral etiology. According to the WHO recommendations, vaccination against rotavirus infection should be included into national immunization programs. Due to a wide diversity of circulating rotavirus genotypes, the issue of RVI vaccine efficiency, taking into account the dynamics of the molecular-genetic spectrum of RVI pathogens over time, remains relevant. The aim of the work – мodeling the dynamics of the molecular genetic spectrum of RVI pathogens and bioinformation analysis of f rotavirus vaccine efficiency. The object of the analysis was the results of molecular and epidemiological studies of RVI in Kyiv, conducted from 2007 to 2015. The dynamics of the genotypic spectrum was modeled using a Markov model, which involved replacing shares of the molecular genetic spectrum of rotaviruses with others ones according to homology with the vaccine strain: homology in both G and P genotypes, homology in G genotype or P genotype, no homology in both G and P genotypes. The method of rotavirus vaccine efficiency evaluation is based on data from clinical observations of vaccine efficiency, where different degrees of its efficiency against severe gastroenteritis caused by rotaviruses with different genotypes were shown. The shares of each genotype group in the general circulation of genotypes were taken as weights of the degree of homology relative to the vaccine strain, and the effectiveness of the vaccine against the strains of a specific homology group was obtained from clinical observations. The results of the analysis based on the constructed distribution curves of the molecular genetic spectrum of rotaviruses due to rotavirus vaccine strain homology in Kiev showed that, despite the observed dynamics of the molecular genetic spectrum of RVI pathogens, the expected genotype-specific efficiency of rotavirus vaccine would be constant with a value of 0.835 or 83.5% against rotavirus gastroenteritis with a Vesikari severity of > 11 points. It was proposed mathematical model for prediction of molecular genetic spectrum of rotaviruses dynamics, taking into account the homology of the genotypes of RVI pathogens with respect to the vaccine strain. According to the literature data of molecular and epidemiological studies of rotaviruses in Kyiv, the parameters of the proposed mathematical model and the dynamics of the molecular genetic spectrum of RVI pathogens were determined. Using mathematical modeling, the expected genotype-specific efficiency of the rotavirus vaccine was determined based on Kyiv regional retrospective molecular and epidemiological data

Rotaviruses and Noroviruses as Etiological Agents of Acute Intestinal Diseases of Ukrainian Children

Background: Rotavirus and norovirus infections are the primary viral causes of childhood diarrhea. In Ukraine, the diarrhea-linked infant mortality rate is low, but the number of children infected is quite high. This study examined the rates of rotavirus and norovirus infections throughout Ukraine. Methods: Fecal samples for children admitted to hospitals in six Ukrainian cities (Kyiv, Lviv, Sumy, Odesa, Kharkiv, and Uman) were tested for the presence of rotavirus and norovirus. Results: The overall rate of hospitalized children suffering from diarrhea with confirmed presence of rotavirus or norovirus in fecal samples was significant (20.67% and 27.94%, respectively). Samples obtained from children from Lviv had significantly higher rates of the viruses, and Kyiv and Uman had significantly lower rotavirus or norovirus detection levels than expected. Conclusion: Childhood diarrhea impacts Ukraine significantly. The economic and societal effects of the failure to address this public health issue are indicated by the hospitalization rate of children with preventable illnesses. The geographical disparities in Ukraine for child hospitalizations caused by rotavirus and norovirus infections could result from environmental (sanitary factors or water purity issues) or social factors. Further research is needed to completely characterize infant viral infections in Ukraine

Rotaviruses and Noroviruses as Etiological Agents of Acute Intestinal Diseases of Ukrainian Children

(1) Background: Rotavirus and norovirus infections are the primary viral causes of childhood diarrhea. In Ukraine, the diarrhea-linked infant mortality rate is low, but the number of children infected is quite high. This study examined the rates of rotavirus and norovirus infections throughout Ukraine. (2) Methods: Fecal samples for children admitted to hospitals in six Ukrainian cities (Kyiv, Lviv, Sumy, Odesa, Kharkiv, and Uman) were tested for the presence of rotavirus and norovirus. (3) Results: The overall rate of hospitalized children suffering from diarrhea with confirmed presence of rotavirus or norovirus in fecal samples was significant (20.67% and 27.94%, respectively). Samples obtained from children from Lviv had significantly higher rates of the viruses, and Kyiv and Uman had significantly lower rotavirus or norovirus detection levels than expected. (4) Conclusion: Childhood diarrhea impacts Ukraine significantly. The economic and societal effects of the failure to address this public health issue are indicated by the hospitalization rate of children with preventable illnesses. The geographical disparities in Ukraine for child hospitalizations caused by rotavirus and norovirus infections could result from environmental (sanitary factors or water purity issues) or social factors. Further research is needed to completely characterize infant viral infections in Ukraine

Apixaban versus Enoxaparin for Thromboprophylaxis in Medically Ill Patients

BACKGROUND: The efficacy and safety of prolonging prophylaxis for venous thromboembolism in medically ill patients beyond hospital discharge remain uncertain. We hypothesized that extended prophylaxis with apixaban would be safe and more effective than short-term prophylaxis with enoxaparin. METHODS: In this double-blind, double-dummy, placebo-controlled trial, we randomly assigned acutely ill patients who had congestive heart failure or respiratory failure or other medical disorders and at least one additional risk factor for venous thromboembolism and who were hospitalized with an expected stay of at least 3 days to receive apixaban, administered orally at a dose of 2.5 mg twice daily for 30 days, or enoxaparin, administered subcutaneously at a dose of 40 mg once daily for 6 to 14 days. The primary efficacy outcome was the 30-day composite of death related to venous thromboembolism, pulmonary embolism, symptomatic deep-vein thrombosis, or asymptomatic proximal-leg deep-vein thrombosis, as detected with the use of systematic bilateral compression ultrasonography on day 30. The primary safety outcome was bleeding. All efficacy and safety outcomes were independently adjudicated. RESULTS: A total of 6528 subjects underwent randomization, 4495 of whom could be evaluated for the primary efficacy outcome--2211 in the apixaban group and 2284 in the enoxaparin group. Among the patients who could be evaluated, 2.71% in the apixaban group (60 patients) and 3.06% in the enoxaparin group (70 patients) met the criteria for the primary efficacy outcome (relative risk with apixaban, 0.87; 95% confidence interval [CI], 0.62 to 1.23; P=0.44). By day 30, major bleeding had occurred in 0.47% of the patients in the apixaban group (15 of 3184 patients) and in 0.19% of the patients in the enoxaparin group (6 of 3217 patients) (relative risk, 2.58; 95% CI, 1.02 to 7.24; P=0.04). CONCLUSIONS: In medically ill patients, an extended course of thromboprophylaxis with apixaban was not superior to a shorter course with enoxaparin. Apixaban was associated with significantly more major bleeding events than was enoxaparin. (Funded by Bristol-Myers Squibb and Pfizer; ClinicalTrials.gov number, NCT00457002.)