Tularemia Outbreak among the Population of Khanty-Mansiisk and the Khanty-Mansiisk Region, Occurred in 2013

Natural tularemia foci in the territory of the Khanty-Mansiisk Autonomous District - Yugra are still active and sustainable ones despite of the extended periods of epidemiological welfare. Agent reservoir is the water vole. However, recently tularemia agent has been detected in the northern red-backed vole and common red-toothed shrew. Khanty-Mansiisk town, Berezovsky, Khanty-Mansiisk, Kondinsky, and Oktyabr’sky Regions are situated in the territory of the most active foci. Serious outbreaks of infection among the population occur with an interval up to 30 years. Their transmissibility preconditions the scale and intensiveness. All cohorts are under the risk of exposure, irrespective of the age and occupation, including the infants. The paper discusses tularemia outbreak impact on the population of Khanty-Mansiisk and the Khanty-Mansiisk Region in July-October, 2013. Casualty toll is 1005 cases. Given is a brief retrospective analysis of epidemiological situation on tularemia since 1930-s up to the onset of the outbreak under investigation. Described is the experience in management of the response activities

НЕПРОНИКАЮЩАЯ ГЛУБОКАЯ СКЛЕРЭКТОМИЯ И ИМПЛАНТАЦИЯ ДРЕНАЖА EX-PRESS R-50 В ХИРУРГИЧЕСКОМ ЛЕЧЕНИИ ГЛАУКОМЫ

PURPOSE: Analysis of the mediumand long-term results of the mini-shunt Ex-Press implantation in glaucoma surgical treatment.METHODS: Non-penetrating deep sclerectomy with the mini-shunt Ex-PRESS R-50 implantation was performed in 198 eyes of 177 patients with uncontrolled and/or refractory glaucoma between 2011 and 2014. Exclusion criteria for patients: signs of neovascularisation, close-angle or congenital glaucoma, previous ophthalmologic surgeries during the last 6 months, the need for simultaneous combined cataract and glaucoma surgery. The study included 161 patients (176 eyes). A review of the patients’ anamnesis revealed a history of previous glaucoma surgical procedures in 126 (77.6%) patients, cataract phacoemulsification with IOL implantation in 108 (67%) patients and vitrectomy in 43 (26.7%) cases. All surgical interventions were undertaken within a period of more than 6 months before the present study. A standard ophthalmologic examination was performed in all patients prior to surgery and on days 1 and 7, as well as 1, 2, 3, 6, 12, 18, 24 and 36 months after the drainage implantation. In a number of patients, examinations were also performed 48 (n=44, 27.3%) and 60 (n=21, 13%) months after the operation. In addition, patients were divided into group I («phakic» glaucoma, n=53; 32.9%) and group II (pseudophakic glaucoma, n=108; 78.3%)RESULTS: The mean follow-up period was 43.7±2.9 months. The mean age of patients at the time of surgery was 72.4 ± 9.6 years, with 63 (39.1%) male and 98 (60.9%) female patients. IOP decrease compared to preoperative values of 32.3±8.7 mmHg amounted to 6.2±7.7 mm Hg after 1 week, 11.9±5.8 mm Hg after 1 month, 12.5±4.0 mm Hg after 2 months, 12.7±4.8 mm Hg after 3 months, 12.1±4.5 mm Hg after 6 months, 11.7±4.2 mm Hg after 12 months, 12.9±5.1 mm Hg 18 months after surgery. At the follow-up period of 24 months, the IOP decreased to 15.3±6.6 mm Hg, and at follow-ups of 36 months to 17.5±6.8 mm Hg (45.8%). In 44 (27.3%) patients 48 months later, the IOP level exceeded the compensation level with average values of 22.4±8.0 mm Hg. In 60 months after the operation 21 (13%) patients had a mean IOP level of 26.1±8.2 mm Hg. A statistically insignificant change in BCVA from 0.61±0.25 in the preoperative period to 0.57±0.31 during the last examination was observed (p>0.1). There was a significant decrease in the number of glaucoma instillations with the average numbers of 0.55±1.1 and 0.89±1.2 24 and 36 months after the surgery respectively, compared to 2.7±0.9 prior to the surgery (p=0.002 and p=0.01). In all the investigated cases, a daily massage of the filtration zone was performed during the postoperative period. In 94 (58.4%) patients, the IAG laser procedure was performed on the shunt at various postoperative times. Postoperative complications included a transient hypotension in the early (10-14 days) postoperative period, Seidel’s symptom and bleb encapsulation, which required additional intervention. At the maximum follow-up period of 36 months, somewhat better results were obtained in group II (mean IOP 15.9±4.2 mm Hg vs. 17.3±4.4 mm Hg in group I, p>0.1). Similar differences were obtained for the number of glaucoma drugs taken (0.81±0.9 in group II against 0.97±1.1 in group I, p>0.1). Larger differences were obtained for BCVA during the long-term follow-up period (0.62±0.26 in group II versus 0.38±0.21 in group I, 0.05<p<0.1).CONCLUSION: Ex-PRESS mini-shunt implantation is indicated in patients with refractory glaucoma when with previous interventions and maximum antihypertention regimen proved insufficient to compensate intraocular pressure level. Relative simplicity of the implantation technique, a small percentage of complications and a high efficiency in the medium term observation period make it possible to recommend the use of this device for wide ophthalmic surgical practice. Optimal results are possible with the implantation of a mini-shunt under the superficial scleral flap and a special mode of postoperative management of the patient, which allows to maintain the functioning of the shunt and to provide a tolerant intraocular pressure. Implantation of the mini-shunt Ex-PRESS R-50 in patients with pseudophakia results in slightly better but statistically insignificant functional results, however, due to the reduction in the effect in long-term (up to 5 years) follow-up, this surgical intervention is not an operation of first choice for this group of patients.ЦЕЛЬ. Анализ среднеи долгосрочных результатов имплантации мини-шунта Ex-PRESS в лечении глаукомы.МЕТОДЫ. Непроникающая глубокая склерэктомия с имплантацией мини-шунта Ex-PRESS R-50 проведена на 198 глазах 177 пациентов с неконтролируемой и/или рефрактерной к медикаментозной терапии глаукомой в период с 2011 по 2014 гг. Критерии исключения пациентов: наличие неоваскулярной, закрытоугольной или врожденной глаукомы, предшествующие офтальмологические оперативные вмешательства в течение последних 6 месяцев, необходимость одномоментной комбинированной хирургии катаракты и глаукомы. В исследование включен 161 пациент (176 глаз). В анамнезе у 126 (77,6%) пациентов отмечено проведение других антиглаукомных хирургических вмешательств, у 108 (67%) пациентов была выполнена факоэмульсификация катаракты с имплантацией ИОЛ, 43 (26,7%) пациентам проведена витрэктомия, при этом все хирургические вмешательства были выполнены в сроки более 6 месяцев перед настоящим исследованием. Стандартное плановое офтальмологическое обследование всем пациентам выполняли до хирургического вмешательства и в сроки 1 день, 7 дней, 1, 2, 3, 6, 12, 18, 24 и 36 месяцев после имплантации дренажа. У части пациентов осмотры проводили также в 48 (n=44; 27,3%) и 60 (n=21; 13%) месяцев после операции. Дополнительно проведено разделение пациентов на группу 1 («факичная» глаукома; n=53; 32,9%) и группу 2 (артифакичная глаукома; n=108; 78,3%).РЕЗУЛЬТАТЫ. Средний период наблюдения составил 43,7±2,9 месяцев. Средний возраст пациентов на момент хирургического вмешательства 72,4±9,6 года, из них 63 (39,1%) мужчины и 98 (60,9%) женщин. Отмечено снижение внутриглазного давления (ВГД) по сравнению с дооперационными значениями 32,3±8,7 до 6,2±7,7 мм рт.ст. через 1 неделю, 11,9±5,8 мм рт.ст. через 1 месяц, 12,5±4,0 — через 2 месяца, 12,7±4,8 — через 3 месяца, 12,1±4,5 — через 6 месяцев, 11,7±4,2 — через 12 месяцев, 12,9±5,1 мм рт.ст. через 18 месяцев после хирургического вмешательства

METHOTREXATE AND PROTON PUMP INHIBITORS: ARE THERE ANY NEGATIVE PHARMACOLOGIAL EFFECTS?

Methotrexate (MTX) is the first-line medication to treat rheumatoid arthritis (RA). However, it may have serious adverse effects (AE) on liver, kidneys, hematopoietic system, etc., thus requiring meticulous control over patient’s condition and the dynamics of laboratory indicators. A number of drugs may affect MT pharmacokinetics and increase its toxicity. In theory, proton pump inhibitors (PPIs) may have this effect. Objective. To assess the relationship between the coadministration of MT and PPIs and the risk for developing drug-induced complications.Material and Methods. A retrospective analysis of clinical symptoms and laboratory indicators in 539 RA patients (median age, 52.5±14.6 years; 86.8% females and 13.2% males) who received MTX in 2009–2011 was carried out. Fifty-two patients who received PPIs on a regular basis were included in the study. The control group consisted of 104 PPI-naive patients comparable in terms of gender, age, and therapy. The numbers of patients with increased levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT), alkaline phosphatase (ALP); anemia (hemoglobin level < 110 g/l in females and <120 g/l in males), leukopenia (<4.0•109/l), elevated creatinine level, and proteinurea (qualitative and quantitative values) were compared.Results. No significant intergroup differences were revealed. MTX showed no clinically manifested AE. The odds ratio (OR) and 95% confidence interval (CI) for changes in laboratory indicators were as follows: ALT 1.35 (95% CI 0.22–8.32), AST 0.66 (95% CI 0.13–3.38), ALP 0.98 (95% CI 0.955–1.01), anemia 1.19 (95% CI 0.517–2.71), and proteinurea 1.95 (95% CI 0.83–4.59; р=0.17). A small increase in the creatinine level was observed in one case for each group.Conclusions. The results showed no significant increase in toxicity when low doses of MTX and PPIs were coadministered in RA patients. There was a trend towards more frequent proteinurea in patients who received both drugs. This fact requires further research

MAGNETIC RESONANCE IMAGING OF THE LIVER AND SPLEEN IN THE DIAGNOSIS OF STORAGE DISEASES (literature review)

Storage diseases (thesaurismosis, storage reticuloses) are the complex and extensive group of diseases in which differential diagnosis of pathological changes from the internal organs is difficult. For diagnosis and dynamic observation of liver and spleen lesions, ultrasound and X-ray computed tomography are used among imaging techniques. Among the imaging techniques for diffuse liver diseases, ultrasonography and X-ray computed tomography are most commonly used for their diagnosis and follow-up. Magnetic resonance imaging (MRI) has the highest sensitivity and specificity in diagnosing liver diseases.The article considers the current MRI procedures that are used to diagnose storage diseases and to quantify found changes. For Gaucher disease, the potentials of such novel technique as magnetic resonance spectroscopy are described. Incorporation of MRI into the examination algorithm for patients with storage diseases will be able to improve the detection of these rare diseases and to monitor the efficiency of performed therapy

Subjective Well-Being of High School Students Belonging to Indigenous Peoples of the North as a Basis for Readiness to Choose a Profession

Introduction.The preservation and well-being of the indigenous peoples of the Russian North is directly related to the national identity, the values for sustaining vital activities, the continuation and development of traditional crafts. Thus, the professional self-determination of the oncoming generation from the Russian North is the basis for the preservation of their national heritage.The aim of the present publication was to determine the subjective grounds for the formation of personal readiness to choose a profession among high school students studying and living in the Arctic.Methodology and research methods. the empirical base of the research was formed by the obtained data using psychodiagnostic tools. The indicators were the subjective well-being of schoolchildren and their readiness for professional selfdetermination. 119 high school students aged 14-17 from educational institutions of the Yamal-Nenets Autonomous District of the Tyumen Region and the city of Tyumen took part in the testing of these complex constructs. The statistical data analysis was carried out along with comparative and correlation analyses.Results. The research results show the interrelated differences between indicators of subjective well-being and readiness to choose a profession among indigenous high schools students of the Russian North and their non-indigenous peers. The analysis of the statistical validity of differences using the Student’s t-test demonstrated that high school students of the indigenous minorities of the Russian North have higher rates of psycho-emotional stability. Also, they are more independent and optimistic about choosing a profession. The results of the correlation analysis revealed that indigenous high school students of the Russian North have certain advantages over their non-indigenous peers when coping with the challenges of choosing a career. For instance, indigenous high school students are much less dependent on the indicators of subjective well-being. Their stronger psycho-emotional response to harsh living conditions increases their motivation for early professional self-determination.Scientific novelty. The current study enhances the understanding of the influence of relationships between personal characteristics and subjective well-being on the readiness to choose a career by graduates of secondary schools located in the Arctic.Practical significance. The research findings and conclusions could be exploited in order to build up more accurate and targeted system of career guidance support for high school students of the indigenous peoples of the North, as well as for other nationalities living in harsh climatic conditions

Socio-demographic portrait of transsexual patients in Russia

Transsexualism is a distress caused by a discrepancy between a person’s gender identity and sex assigned at birth. Theme of  transsexualism has a strong resonance in society today. This phenomenon is significant both for the law system and for the health  care system of the state. There is no statistics information on transgender people in Russian Federation. The author’s goal was to  draw a socio-demographic portrait of patients with an established diagnosis of transsexualism. The following conclusions were  made: the number of MtF and FtM patients searching for medical care is equal; age of the transition is 26.6 years; age of selfidentification in the opposite gender is 10.2 years; most MtF take HRT on their own initative; transsexual persons are distinguished  by a high level of education, large variety of professional activities, a low percentage of registered marriages, and comparable to the  general population onset of sexual life