Features of the course and effectiveness of treatment of tuberculosis in pregnant women with different HIV status

The study presents the results of comparing the social status and the efficiency of TB treatment in pregnant women with or without HIV treated in Krasnoyarsk Regional TB Clinic № 1 in the years 2010–2014. It is based on a retrospective analysis of health cards of 133 pregnant TB patients divided into groups: Group 1 (TB), n=109; Group 2 (TB and HIV), n=24. More than a half of the women (51,3% and 54,1% accordingly) were new TB patients, the others had been previously treated for TB. A moderate immunodeficiency was more often detected in co-infected pregnant women (mean CD4+ lymphocyte count being 387 cells/ml), although in 4 patients the CD4 count was lower than 200 cells/ml. The registered rates of bacterioexcretion and lung disintegration were practically the same (57,7% and 58,3% versus 53,2% and 54,1% accordingly); MDR TB was diagnosed in 51,1% in Group 1 and in 60,0% in Group 2.Results: Patients of both groups had various social problems. However, the most aggravating medico-social factor among the co-infected women was active drug abuse during pregnancy (proved in 37,5%). The clinical course of TB in patients with HIV was severer, they more often developed acute forms of the disease. Preterm delivery was more frequent in TB/HIV cases (46,1% vs. 12,3%, p<0,01). Children born by the women with HIV co-infection showed signs of prematurity and intrauterine growth retardation more often than those born by HIV-negative patients (50,0% vs. 12,3%, p<0,01). Treatment efficiency for TB was authentically less in co-infected cases (33,4% vs. 58,7%, p<0,01). TB recurrence was more often registered in HIV-positive patients (25,0% vs. 3,1%, p<0,01). As for chemotherapy tolerance, treatment adherence or lethality rate, no authentic differences between the groups have been revealed

CLINICAL COURSE OF HIV-ASSOCIATED TUBERCULOSIS IN THE PREGNANT WOMAN AND NEWBORN

The article describes the clinical case of TB/HIV coinfection in the pregnant woman and newborn. The discussion of the management tactics included main issues on which treatment success depended on: the right choice of chemotherapy regimen, correct decision on the time of delivery due to life-threatening conditions of the mother, timely diagnostics of tuberculosis in the newborn. It is necessary to develop cross-disciplinary guidelines by professional medical communities on the management of pregnant women with TB/HIV coinfection which will allow enhancing the quality of medical care to pregnant women and newborns at all stages of follow-up

The model of monitoring of vocational pedagogical competences of professors in secondary vocational education

The relevance of the researched issue is preconditioned by the strategic changes in the secondary vocational education system taking place not only in Russia, but also in majority of industrially developed countries. Provision of the system with qualified pedagogical staff is the leading strategic objective of development of the secondary vocational educational system. Its solution must be based on the justified monitoring system, which objectively represents the condition as well as quantitative and qualitative changes taking place in the educational sphere. The article is aimed at developing, substantiating and approbating the model of monitoring of vocational pedagogical competences of professors in secondary vocational education. Integration of the competence, functional and general pedagogical analysis became the leading approach to research into this problem, which has enabled substantiating the model of monitoring of vocational pedagogical competences of professors in the secondary vocational education system. The article presents results of the theoretical and methodological analysis of Russian and foreign research dedicated to identification of key and emerging competences in various spheres. The competence model of a professor of secondary vocational education has been developed and substantiated as a monitoring basis. The article may be useful to improve the quality of the human resource potential in the secondary vocational education system in Russia, to define current and long-range objectives of its development. © 2016 Andryukhina et al

Vocational pedagogical competencies of a professor in the secondary vocational education system: Approbation of monitoring model

The relevance of the researched issue is preconditioned by the strategic changes in the secondary vocational education system taking place not only in Russia, but also in majority of industrially developed countries. Provision of the system with qualified pedagogical staff is the leading strategic objective of development of the secondary vocational educational system. Its solution must be based on the justified monitoring system, which objectively represents the condition as well as quantitative and qualitative changes taking place in the educational sphere. The article is aimed at approbating the model of monitoring of vocational pedagogical competences of professors in secondary vocational education. Integration of the competence, functional and general pedagogical analysis became the leading approach to research into this problem, which has enabled substantiating the model of monitoring of vocational pedagogical competences of professors in the secondary vocational education system. The competence model of a professor of secondary vocational education has been developed and substantiated as a monitoring basis. Results of model approbation and monitoring tools have been presented. The article may be useful to improve the quality of the human resource potential in the secondary vocational education system in Russia, to define current and long-range objectives of its development. © 2016 Andryukhina et al

Внебольничные пневмонии у взрослых больных ВИЧ-инфекцией: особенности течения и лечения, профилактика

This is a review of published data on community-acquired pneumonia (CAP) in adult HIV-infected patients. Morbidity of bacterial pneumonia in HIV-infected patients is 5- to 10-fold higher than that in general population. Wide use of antiretroviral therapy (ARVT) is associated with a reduction in morbidity of CAP in HIV-infected patients, but this reduction is not as significant as for other opportunistic infections. The most important risk factors for CAP are drug abuse, tobacco smoking, HIV-associated immunosuppression, hepatic cirrhosis, not to be treated with ARVT or ARVT withdrawal. Severe, complicated and invasive course of CAP and poor outcomes are seen more often in HIV-infected patients compared to general population. Bacterial pneumonia should be differed from pneumonia caused by Pneumocystis and from tuberculosis, especially in endemic countries and in patients with insidious onset of the disease. The standard therapy of CAP is applied in all patients independently of HIV status. However, administration of fluoroquinolones is restricted in regions with high prevalence of multi-drug resistant tuberculosis in HIV-infected patients before tuberculosis is excluded. Several studies have demonstrated that, in case of false initial diagnosis, 10-day monotherapy with a fluoroquinolone could form the resistance of Mycobacteria tuberculosis against this drug; this significantly complicates further treatment of tuberculosis and increases the treatment cost. Beta-lactams are not effective against tuberculosis; in 2016, WHO excluded macrolides from the list of medications for therapy of tuberculosis due to their low activity against M. tuberculosis. Therefore, empirical therapy of CAP in HIV-infected patients should be started with combination of beta-lactam antibiotic and newer macrolide. A strong protective effect of PPV23 vaccine against CAP was confirmed in HIV-infected patients, but the highest protective efficacy was seen in patients with relatively preserved immunity compared to patients with CD4 < 200 cells × µL-1.По результатам анализа публикаций показано, что заболеваемость бактериальной пневмонией у инфицированных вирусом иммунодефицита человека (ВИЧ) в 5–10 раз превышает показатель в популяции. При широкомасштабном применении антиретровирусной терапии (АРВТ) заболеваемость внегоспитальной пневмонией (ВП) снижается, но не так значительно, как в случае других оппортунистических инфекций. Наиболее значимыми факторами риска развития ВП признаны потребление наркотиков, табакокурение, ВИЧ-ассоциированная иммуносупрессия, цирроз печени и отсутствие АРВТ или перерывы в лечении. Развитие тяжелых, осложненных и инвазивных форм ВП и, как следствие, риск неблагоприятного исхода у больных ВИЧ-инфекцией встречается значительно чаще, чем среди населения в целом. В эндемичных по туберкулезу странах у больных ВИЧ-инфекцией бактериальную пневмонию наиболее часто приходится дифференцировать с пневмоцистной пневмонией и туберкулезом, особенно у лиц с подострым началом заболевания. Базовые принципы лечения ВП одинаковы для всех пациентов вне зависимости от ВИЧ-статуса. Однако в регионах с высоким бременем туберкулеза с множественной лекарственной устойчивостью микобактерий туберкулеза (МБТ) назначение фторхинолона ВИЧ-инфицированному пациенту с неисключенным туберкулезом имеет серьезные ограничения. Показано, что в случае ошибочного первоначального диагноза за 10 дней монотерапии фторхинолоном МБТ формируют устойчивость к препарату, что значительно усложняет и значительно повышает стоимость лечения туберкулеза. β-Лактамные антибактериальные препараты (АБП) не обладают противотуберкулезной активностью, а макролиды по причине чрезвычайно слабой активности в отношении МБТ Всемирной организацией здравоохранения в 2016 г. исключены из списка препаратов для лечения туберкулеза. Поэтому у ВИЧ-инфицированных наиболее оправданным началом стартовой эмпирической терапии ВП является именно комбинация β-лактамного АБП и современного макролида. Доказано, что вакцинация 23-валентной полисахаридной пневмококковой вакциной имеет серьезное проективное действие в отношении развития ВП у пациентов с ВИЧ-инфекцией, однако наиболее высокий индекс профилактической эффективности отмечен у лиц с относительно сохранным иммунитетом, нежели у больных с количеством CD4 < 200 клеток / мкл

ОСОБЕННОСТИ ТЕЧЕНИЯ И ЭФФЕКТИВНОСТЬ ЛЕЧЕНИЯ ТУБЕРКУЛЕЗА У БЕРЕМЕННЫХ С РАЗЛИЧНЫМ ВИЧ-СТАТУСОМ

The study presents the results of comparing the social status and the efficiency of TB treatment in pregnant women with or without HIV treated in Krasnoyarsk Regional TB Clinic № 1 in the years 2010–2014. It is based on a retrospective analysis of health cards of 133 pregnant TB patients divided into groups: Group 1 (TB), n=109; Group 2 (TB and HIV), n=24. More than a half of the women (51,3% and 54,1% accordingly) were new TB patients, the others had been previously treated for TB. A moderate immunodeficiency was more often detected in co-infected pregnant women (mean CD4+ lymphocyte count being 387 cells/ml), although in 4 patients the CD4 count was lower than 200 cells/ml. The registered rates of bacterioexcretion and lung disintegration were practically the same (57,7% and 58,3% versus 53,2% and 54,1% accordingly); MDR TB was diagnosed in 51,1% in Group 1 and in 60,0% in Group 2.Results: Patients of both groups had various social problems. However, the most aggravating medico-social factor among the co-infected women was active drug abuse during pregnancy (proved in 37,5%). The clinical course of TB in patients with HIV was severer, they more often developed acute forms of the disease. Preterm delivery was more frequent in TB/HIV cases (46,1% vs. 12,3%, p<0,01). Children born by the women with HIV co-infection showed signs of prematurity and intrauterine growth retardation more often than those born by HIV-negative patients (50,0% vs. 12,3%, p<0,01). Treatment efficiency for TB was authentically less in co-infected cases (33,4% vs. 58,7%, p<0,01). TB recurrence was more often registered in HIV-positive patients (25,0% vs. 3,1%, p<0,01). As for chemotherapy tolerance, treatment adherence or lethality rate, no authentic differences between the groups have been revealed. Представлены результаты сравнения социального статуса и эффективности лечения туберкулеза у беременных в зависимости от ВИЧ-статуса, находившихся под наблюдением в Красноярском краевом противотуберкулезном диспансере в период с 2010 по 2014 г. Проведен ретроспективный анализ медицинских документов 133 беременных, больных туберкулезом: 1 группа (ТБ) n= 109; 2 группа (ВИЧ-и/ТБ) n=24. Лечение по поводу впервые выявленного туберкулеза получали более половины женщин обеих групп (51,3% и 54,1%), остальные были ранее леченные. У беременных с коинфекцией чаще регистрировали умеренный иммунодефицит (медиана CD4+лимфоцитов – 387 клеток/мкл), однако у 4 женщин количество CD4 клеток не превышало 200. Бактериовыделение из мокроты и распад легочной ткани выявляли практически с одинаковой частотой (в 57,7 и 58,3%; 53,2 и 54,1% случаев соответственно), МЛУ МБТ регистрировали в 51,1% и 60,0% случаев соответственно.Результаты: социальное неблагополучие демонстрировали больные обеих групп, однако у женщин с коинфекцией в качестве наиболее отягощающего меди- ко-социального фактора отмечено активное наркопотребление в период беременности (у 37,5%). Выявлено, что клиническое течение туберкулезного процесса у пациенток с ВИЧ-инфекцией было более тяжелое, чаще регистрировались остропрогрессирующие формы. Преждевременные роды чаще случались у женщин с ВИЧ-инфекцией (46,1% против 12,3%, p<0,01). Дети, рожденные от матерей с коинфекцией (ВИЧ-и/ТБ), чаще имели признаки недоношенности и ЗВУР, чем младенцы от матерей без ВИЧ-инфекции (50,0% против 12,3%, p<0,01). Эффективность курса лечения туберкулеза была достоверно ниже у больных коинфекцией (33,4% против 58,7%, p<0,01). Рецидив туберкулеза чаще регистрировали среди женщин с ВИЧ-инфекцией (25,0% против 3,1%, p<0,01). По переносимости химиотерапии, приверженности к лечению и уровню летальности достоверных различий в группах сравнения не выявлено.

Оказание медицинской помощи пострадавшим при землетрясении в Армении (к 30-летию трагедии)

Abstract. The article presents the organization of specialized medical care to patients with crush syndrome, acute liver and kidney failure (ALKF), and endotoxic shock, who suffered in the earthquake in Armenia, delivered via air ambulance to N.V. Sklifosovsky Research Institute. In the present report we defined characteristics of medical supplies, qualified and specialized treatment of patients with combined trauma.РЕЗЮМЕ. В статье представлена организация оказания специализированной медицинской помощи пациентам с краш-синдромом, острой печеночно-почечной недостаточностью и эндотоксическим шоком, пострадавшим в результате землетрясения в Армении и доставленным воздушным путем в НИИ СП им. Н.В. Склифосовского. В представленном сообщении определены особенности медицинского обеспечения, квалифицированного и специализированного лечения пострадавших с комбинированной травмой

Future Teachers’ Attitude to the Security Problem and Counter Terrorism

The relevance of the theme under study is determined by the problem of ensuring stability and security of the society through young people’s attitude to terrorism. The human community must be able to protect a person’s world outlook, educational, scientific and cultural needs that determine a person’s existence and mental world. One of the key trends in the fight against extremist and terrorist acts in the social environment is their prevention. It is especially important to carry out such preventive measures among young people. The rising generation appears to be the most unprotected category of the population susceptible to the influence of xenophobia destroying traditional values of national cultures and religions which is in a peculiar kind of a spiritual and axiological vacuum. 79 students of 1-5 years of study at the age of 17 - 22 were questioned according to the test-questionnaire ‘Young people’s attitude to terrorism’. Almost all respondents (95%) confirmed that terrorism is dangerous for the society and the problem really exists. Most respondents distinguish such qualities as cruelty, mercenariness, quick temper, and instability when describing a terrorist’s portrait. When analyzing major reasons why people become terrorists, the students gave the first place to striving to feel power over people. Among other important reasons that influence a terrorist’s personality development, they stated commitment to a certain ideology and striving to achieve material wealth. We need an integral system of terrorism prevention including, among other things, its pedagogical foundations. DOI: 10.5901/mjss.2015.v6n3s7p40

Comparison of the results of surgical treatment of patients with Achilles tendon injury at Myerson stage II and III diastasis using plantar muscle flexor tendon

Single-center randomized controlled partially blinded research aimed at the determination of functional results of surgical treatment of patients with Achilles tendon injury of different Myerson stages was carried out in the clinic of Irkutsk Scientific Centre of Surgery and Traumatology. Based on the analysis of surgical treatment of 20 patients with Achilles tendon divided into two groups (with Myerson stage 11 and stage 111 diastasis) we showed the effectiveness of surgical treatment using plantar muscle flexor tendon. We assessed the following criteria: 1) time from the moment of injury, diastasis length, duration of surgery; 2) pain syndrome after the surgery, omission of additional mobility aids and equipment; 3) AOFAS functional results. While the analysis we found statistically significant differences in studied groups by the criteria "time from the moment of injury" and "diastasis length". As the result of the research we found statistically significant differences by "duration of surgery» criterion. In consequence of using plantar muscle flexor tendon as a stabilizing factor at the restoration of Achilles tendon we didn't register the differences between the groups by the level and duration of pain syndrome after the surgery, terms of the omission of additional mobility aids and equipment after the surgery and also in AOFAS functional results