Statistical models and the theory of hypothesis testing in medicine

Purpose: The purpose of this work is to develop statistical approaches for treatment efficiency analysis on a medical case. These methods include the effect evaluation method performed with various preparations in regards to several factors such as the patient‘s blood state and his/her biochemical values. Design/Methodology/Approach: The results of this survey were divided into three groups: the first included the blood biochemistry values before the test, the second — an hour after the test, the the third — two hours after the test. When visually comparing the results of the analyses of the three groups, it was possible to assume that the load of FLC did not significantly affect the biochemistry of the patients' blood. To test this medical assumption, various statistical criteria of the theory of testing statistical hypotheses have been applied. Findings: Statistical analysis of changes in the level of lipase and triglycerides in the biochemical analysis of the blood of patients with chronic pancreatitis after ingestion of food containing medium-chain fatty acids showed that there is no overall disruption in the functioning of the pancreas. Practical implications: Clinical practice has shown that more than 85% of patients tolerated testing with medium chain fatty acids, not experiencing a painful abdominal symptom and other negative consequences of a violation of external secretion of the pancreas. Originality/Value: In clinical practice, the Russian Academy of Medical Sciences for the first time took into account the results of a statistical analysis.peer-reviewe

Self-Assessment and Self-Dependence in Formation of Writing Skills in Foreign Language

The problem of self-dependence of students of higher education institutions is considered. The research urgency is caused by necessity of preparation of specialists able to evaluate critically their own strengths and weaknesses with the goal of self-improvement and professional development, especially necessary for future translators and teachers of foreign language. The review of scientific sources allows to conclude that self-dependence in teaching is manifested in the condition of understanding of the purpose and accountability of the learning process. The fulfillment of these conditions is particularly important in the formation of writing skills in a foreign language, because writing is a difficultly generated kind of speech activity not only because of the lack of knowledge of grammar and vocabulary, but also due to the diversity of traditions in the organization of the text in Russian and foreign languages. Presented authors’ method of a piecemeal assessment of written works, including mutual- and self-assessment, is aimed at formation of students’ ability to identify the advantages and disadvantages of self-completed tasks, and to correct mistakes. The resulting experimental data allow to conclude that this methodology promotes the development of self-dependence of students in learning

Higher Education for Global and Local Sustainable Development

The Russian universities’ contribution to the achievement of sustainable development goals is analyzed from the prospect of globalism crisis and transition to the global-local paradigm of the existence of a society. The authors proceed from the theoretical premise that the internationally recognized threefold concept of sustainable development encompassing economic development, social stability and environmental sustainability is based on the understanding of the development as a process and a result of subjective and objective factors that effective in activity aimed at building the future of the humankind. Sociocultural approach allows considering the universities’ practices on achieving global goals of sustainable development through local (national and cultural) practices: ecological, economical and socially oriented activity and/ or building ecosystems at a local level. The article is aimed to define the universities’ organizational environment and conditions providing the high level of sustainable development goals’ achievement.Universities implement various strategies to introduce the concept of sustainability into the programs of their development. The practices of the universities known for the effective implementation of sustainability concept into educational, research and social practices oriented to the regional sustainable development are analyzed. The universities under consideration provide stimulating ground for establishing horizontal and vertical relationships among all subjects of sustainable development within their educational environment, fostering sustainability culture and motivating students, teachers and other personnel to achieve sustainability goals. Their experience might be informative for Russian Universities as far as the principles of sustainable development and orientation at building educational ecosystems are formulated in the national programs of regional development in Russia (Flagship Universities Program and Priority 2030 Program). In the Priority 2030 Program, the ecosystem principle is one of the fundamental for the result-oriented innovative development of regional clusters created by the joint efforts of universities, businesses, state and social organizations. However, Russian universities in their striving for designing educational ecosystem mostly focus on research and financial aspects than on the development of a man, whose professional, intellectual and moral formation might contribute to the sustainable development of the region, the nation and the world

Клинико-лабораторный алгоритм диагностики острой цитомегаловирусной инфекции у детей

The aim. of the study is to optimize the Iaboratory diagnosis of cytomegaIovirus infection in chiIdren by finding cIinicaI and Iaboratory predictors corresponding to the acute stage of infection.MateriaIs and methods. The resuIts of 65 chiIdren age from 1 to 3 years outpatient of with cytomegaIovirus mono-nucIeosis are presented. Markers of herpes virus infections (CMV, EBV, HHV-6 type) were determined by PCR-reaI time (bIood, saIiva) and seroIogicaIIy (IgM, IgG).ResuIts. It has been estabIished. that acute cytomegaIovirus infection can occur both, in the form of infectious mononu-cIeosis and. be atypicaI accompanied, by proIonged fever and. severe Iymphadenopathy in most cases. Indirect Iaboratory markers of acute cytomegaIovirus infection are neutropenia and. hypoimmunogIobuIinemia IgA and. IgG. Acute cytomeg-aIovirus infection is accompanied by the virus shedding in both bIood and saIiva in aImost aII patients and the median vaIues of the viraI Ioad are different: 3,9 Ig DNA copies / mI for bIood, 4,9 Ig DNA copies / ml for saIiva. Using mathemati-caI modeIing, the “cut off" vaIue of viraI Ioad. for saIiva was determined, to be 4,1 Ig DNA copies / mI corresponding to 65.0% of the probabiIity of deveIoping acute CMV infection.ConcIusion. The study made it possibIe to substantiate the aIgorithm. for diagnosing acute cytomegaIovirus infection. in young chiIdren which. incIudes the most significant cIinicaI Iaboratory predictors, as weII as the caIcuIated. “cut off" vaIue of viraI Ioad. for saIiva equaI to 4,1 Ig DNA copies / mI. Determining the viraI Ioad in the saIiva of patients can be used, as an additionaI diagnostic criterion for the atypicaI form of acute cytomegaIovirus infection.Цель: оптимизировать лабораторную диагностику цитомегаловирусной инфекции у детей путем, определения клинических и лабораторных предикторов, соответствующих острой стадии инфекции.Материалы и методы: представлены, результаты, амбулаторного наблюдения 65 детей с цитомегалови-русным мононуклеозом. в возрасте от. 1 до 3 лет.. Маркеры. герпес-вирусных инфекций (ЦМВ, ВЭБ, ВГЧ-6 типа) определяли методом. ПЦР-reaI time (кровь, слюна) и серологически (IgM, IgG).Результаты: установлено, что острая цитоме-галовирусная инфекция может, как протекать в виде инфекционного мононуклеоза, так и быть атипичной, сопровождаясь длительной лихорадкой и выраженной лимфаденопатией в большинстве случаев. Косвенными лабораторными маркерами острой цитомегаловирусной инфекции являются нейтропения и гипоиммуногло-булинемия IgA и IgG. Острая цитомегаловирусная инфекция сопровождается выделением вируса как в кровь, так и в слюну практически у всех пациентов, причем, значения медиан вирусной нагрузки различны: для крови 3,9 Ig копий ДНК/мл, для слюны. — 4,9 Ig копий ДНК/мл. С помощью математического моделирования определено «пороговое» значение вирусной нагрузки для слюны., равное 4,1I g копий ДНК/мл, соответствующее 65,0% вероятности развития острой ЦМВИ.Заключение: проведенное исследование позволило обосновать алгоритм, диагностики острой цитомегаловирусной инфекции у детей раннего возраста, включающий в себя наиболее значимые клинико-лабораторные предикторы, а также рассчитанное ««пороговое» значение вирусной нагрузки для слюны, равное 4,1 Ig копий ДНК/мл. Определение вирусной нагрузки в слюне пациентов можно использовать как дополнительный диагностический критерий при атипичной форме острой цитомегаловирусной инфекции

Тяжелый грипп как фактор риска развития инвазивного аспергиллёза лёгких (клинический случай)

During  last  years  the  frequency  of  invasive  pulmonary aspergillosis  (IPA)  in  immunocompetent  patients  has  increased. Clinical case report of successful treatment invasive aspergillosis  with  influenza  A(H1N1)  presented  in  the  article. We analyzed the special literature of patients with IPA following influenza infection. The timely identification and treatment of these patients are necessary.В последние годы увеличилась частота инвазивного аспергиллеза у больных без типичных факторов риска. В статье представлен случай успешного лечения инвазивного аспергиллёза лёгких, возникшего на фоне гриппа A(H1N1), и обзор литературы. Показана необходимость своевременной диагностики и адекватной антимикотической терапии у больных тяжелым гриппом

ГЕРПЕСВИРУСНЫЕ ИНФЕКЦИИ У ДЕТЕЙ С РЕЦИДИВИРУЮЩИМИ РЕСПИРАТОРНЫМИ ЗАБОЛЕВАНИЯМИ

The article presents the role of herpesviral infections caused by the herpes simplex virus (HSV), the Epstein-Barr virus (EBV), cytomegalovirus (CMV) and human herpesvirus type 6 (HHV-6) in 36 children with recurrent respiratory tract diseases at the age from 1 to 18 years. Blood sera and blood cells were studied using ELISA, Indirect reaction of immunofluorescence and Rapid culture method.It was found that all 36 children (100%) were infected with HSV, EBV, CMV and HHV-6. Most often — in 19 children (52.8%) the signs of active HHV-6 were revealed. In the same number of children surveyed, it was possible to identify active EBVI (16 children — 44.4%) and CMVI (16—44.4%). Active HSVI was diagnosed in 13 children (36.1%). Herpes virus infections were most often detected in the age group of children from 3 to 7 years of age.All children with recurrent respiratory diseases should be examined for herpesvirus infections.В статье представлена роль герпесвирусных инфекций, вызванных вирусом простого герпеса (ВПГИ), вирусом Эпштейна-Барр (ВЭБИ), цитомегаловирусом (ЦМВИ) и вирусом герпеса человека 6-го типа (ВГЧИ-6) у 36 детей с рецидивирующими заболеваниями верхних дыхательных путей в возрасте от 1 года до 18 лет. Исследовали сыворотки крови и клетки крови методами ИФА, НРИФ и БКМ.Установлено, что все 36 детей (100%) были инфицированы ВПГ, ВЭБ, ЦМВ и ВГЧ-6. Наиболее часто — у 19 детей (52,8%) были выявлены признаки активной ВГЧИ-6. У одинакового числа обследованных детей удалось выявить активную ВЭБИ (16 детей — 44,4%) и ЦМВИ (16 — 44,4%). Активную ВПГИ диагностировали у 13 детей (36,1%). Герпесвирусные инфекции наиболее часто выявлялись в возрастной группе детей от 3 до 7 лет жизни.Таким образом, необходимо всех детей с рецидивирующими респираторными заболеваниями обследовать на герпесвирусные инфекции

Клинико-эпидемиологические особенности ВГЧ-6А- и ВГЧ-6В-инфекции у детей г. Москвы

Human herpes virus type 6 (HHV-6) is the etiological agent of plenty diseases. The form of the developing pathology depends on the localization of the virus in T-lymphocytes and on virus type: HHV-6A or HHV-6B, but identification of the type is possible by nucleotide sequence only. In Russia, researching on the typing of HHV-6 are conducted in Moscow and St. Petersburg mainly, but results is discordant. Also the prevalence of HHV-6A and HHV-6B among various population groups is of particular interest.Вирус герпеса человека 6 типа (ВГЧ-6) является этиологическим агентом множества заболеваний. Форма развивающейся патологии зависит от локализации вируса в T-лимфоцитах и от его типа: ВГЧ-6А или ВГЧ-6В, но идентификация типа возможна только по нуклеотидной последовательности. В России типирование ВГЧ-6 проводится в основном в Москве и Санкт-Петербурге. Особый интерес вызывает распространенность ВГЧ-6А и ВГЧ-6В среди различных групп населения

Инвазивный аспергиллез у взрослых пациентов с ревматическими заболеваниями

Objective: to study risk factors for invasive aspergillosis (IA), its etiology, clinical manifestations, and treatment efficiency in patients with rheumatic diseases (RD).Patients and methods. The first study of proven and probable IA (EORT/MSGERC, 2019) was conducted in 18 patients with RD, who accounted for 3% of all adult IA patients (n=699) included in the 1998–2020 registry of the Department of Clinical Mycology, Allergology, and Immunology, I.I. Mechnikov North-Western State Medical University (Group 1). This group comprised 56% women; the median age was 59 [21; 75] years. Group 2 (a comparison group) included 610 adult hematology patients with IA (median age, 45 [18; 79] years; 42% women). A prospective case-control study was conducted to identify risk factors for IA in patients with RD: 36 rheumatic patients without IA (median age, 58 (18–79) years; 61% women) (a control group).Results and discussion. Patients with RD were found to often develop IA in the presence of anti-neutrophilic cytoplasmic antibody-associated vasculitis (granulomatosis with polyangiitis and microscopic polyangiitis) and systemic lupus erythematosus (50 and 16%, respectively). It was shown for the first time that the likelihood of IA in patients with RD increases with prolonged (median 14 days) lymphocytopenia during RD treatment (odds ratio 13.0; 95% confidence interval, 3.3–50.3). The main causative agents of IA were A. fumigatus (50%) and A. niger (29%). IA was more severe in Group 1 than in Group 2: in the resuscitation and intensive care units, there were 44 and 18%, respectively (p=0.01). Group 1 versus Group 2 more frequently had respiratory failure (61 and 37%, respectively; p=0.03), hemoptysis (28 and 7%; p=0.0001), chest pain (17 and 7%; p=0.04), and cardiac involvement (11 and 1%; p=0.0001), and less frequently had fever (67 and 85%; p=0.01). The common site of IA was the lung (83%); the characteristic feature detected by computed tomography (CT) is pulmonary cavitation (44%). Antifungal therapy was used in 89% of Group 1 patients; the overall 12-week survival was 69%.Conclusion. In patients with RD, it is difficult to differentiate between the progression of the underlying disease, adverse drug reactions, infectious complications, or a combination of these disorders due to the similarity of their clinical manifestations. When RD patients with infectious syndrome and respiratory failure develop prolonged lymphocytopenia during combination therapy, AI should be suspected and lung CT, bronchoscopy, and mycological examination of the material obtained by bronchoalveolar lavage be done.Цель исследования – изучение факторов риска развития, этиологии, особенностей клинических проявлений и эффективности лечения инвазивного аспергиллеза (ИА) у пациентов с ревматическими заболеваниями (РЗ).Пациенты и методы. Проведено первое исследование «доказанного» и «вероятного» (EORTС/MSGERC, 2019) ИА у 18 пациентов с РЗ, которые составили 3% всех взрослых больных ИА (n=699), включенных в регистр, созданный на базе кафедры клинической микологии, аллергологии и иммунологии ФГБОУ ВО «Северо-Западный государственный медицинский университет им. И.И. Мечникова» (1998–2020 гг.) – 1-я группа. В этой группе было 56% женщин, медиана возраста – 59 [21; 75] лет. Во 2-ю группу (группа сравнения) вошли 610 взрослых пациентов с гематологическими заболеваниями, страдающих ИА (медиана возраста – 45 [18; 79] лет, женщины – 42%). Для изучения факторов риска ИА у пациентов с РЗ было проведено проспективное исследование случай-контроль, в которое включили 36 взрослых пациентов с РЗ без ИА (медиана возраста – 58 [18; 79] лет, женщины – 61%) – контрольная группа.Результаты и обсуждение. Установлено, что у пациентов с РЗ ИА чаще развивается на фоне васкулитов, ассоциированных c антинейтрофильными цитоплазматическими антителами (гранулематоз с полиангиитом и микроскопический полиангиит), и системной красной волчанки (соответственно в 50 и 16% случаев). Впервые было показано, что вероятность возникновения ИА у пациентов с РЗ повышается при длительной (медиана – 14 дней) лимфоцитопении на фоне лечения РЗ (отношение шансов 13,0; 95% доверительный интервал 3,3–50,3). Основными возбудителями ИА были A. fumigatus (50% случаев) и A. niger (29%). В 1-й группе ИА протекал более тяжело, чем во 2-й: в отделениях реанимации и интенсивной терапии находились 44 и 18% больных соответственно (p=0,01). В 1-й группе чаще, чем во 2-й, отмечались дыхательная недостаточность (61 и 37% соответственно; p=0,03), кровохарканье (28 и 7%; p=0,0001), боль в грудной клетке (17 и 7%; p=0,04), поражение сердца (11 и 1%; p=0,0001), реже – лихорадка (67 и 85%; p=0,01). Основной локализацией ИА были легкие (у 83% больных), характерный признак, определяемый при компьютерной томографии (КТ), – наличие полостей деструкции (44% случаев). Антифунгальную терапию получали 89% больных 1-й группы, общая выживаемость в течение 12 нед составила 69%.Заключение. У пациентов с РЗ сложно провести дифференциальную диагностику между прогрессированием основного заболевания, неблагоприятными реакциями лекарственной терапии, инфекционным осложнением или комбинацией этих нарушений из-за сходства их клинических проявлений. При развитии длительной лимфоцитопении на фоне комплексной терапии у пациентов с РЗ, имеющих инфекционный синдром и дыхательную недостаточность, следует заподозрить ИА и провести обследование: КТ легких, бронхоскопию и микологическое исследование материала, полученного при бронхоальвеолярном лаваже.

Recombinant interferons in comprehensive therapy for new coronavirus infection

The second decade of the 21st century has brought us a new coronavirus infection, SARS-CoV-2, which affects not only animals (livestock, companion animals, birds), but also people, causing severe disease in them (COVID-19) with various clinical variants: From upper respiratory tract lesions to sepsis and thromboembolism. Coronaviruses are known to suppress the production of IFN-I. Therefore, administration of IFN-I is a promising strategy for early treatment and prevention of COVID-19. In the Russian Federation, treatment of COVID-19 in children is performed in accordance with the recommendations of the Ministry of Health of Russia and depends on the clinical form of the disease. Mild and moderate forms of the disease, observed in the majority of children, are treated according to the protocols for managing ARVI, bronchitis, bronchiolitis, and pneumonia in children. However, the fact that non-severe COVID-19 shares clinical manifestations with other infections caused by respiratory viruses and herpesviruses (including cytomegalovirus, HHV6A/B, and Epstein-Barr virus), as well as recently increased proportion of mixed viral infections necessitate (until the etiological diagnosis is confirmed) the administration of drugs recommended for the treatment of seasonal ARVI (including intranasal forms of IFN-α, etc.). Such therapeutic tactics often ensures faster improvement and symptom elimination. We report a case of mixed respiratory infection caused by two viruses (SARS-CoV-2 and Epstein–Barr virus) in a child. Early treatment with recombinant interferon-α2b with taurine resulted in fever alleviation and normalization of child’s condition by the moment of transfer to a specialized department