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

THE CHARACTERISTICS OF MORTALITY OF THE POPULATION OF IRKUTSK FROM EXTERNAL REASONS AND SOME DISEASES RELATED ETHYL ALCOHOL CONSUMPTION

To our mind, the population alcoholization is the one of the major medical-social problems in Irkutsk region. According to official statistics it is established that in recent years the average index of incidence with diagnosis of an alcoholism and alcoholic psychosis established for the first time as a whole was higher in Irkutsk region, than in the Russian Federation and Siberian Federal district -1,7 and 1,5 times respectively. Sociological polls of the population of Irkutsk showed that 10 % of adult population and less than 20 % of youth do not take alcoholic drinks only. Abuse of alcohol makes a particular contribution to increase in number of lethal cases from diseases of system of blood circulation and the external reasons (mechanical trauma, suicides). It is not possible to estimate these indexes according to statistical data. The purpose of the real research was studying of a share of deadly outcomes among the population of Irkutsk, associated with ethyl alcohol. The profound personified analysis of mortality of the population of Irkutsk from the external reasons and some diseases (according to the international classification of diseases of the 10th revision) was carried out according to archive of Irkutsk regional bureau of a forensic medical expertise during 2000-2012, in cases when ethyl alcohol was found in cadaver blood. It was established, that the share of acute poisonings with ethyl alcohol makes about 4 % in structure of common mortality of the population of Irkutsk. The share of persons of young age of the dead as a result of an acute alcoholic poisoning makes nearly 20 % in recentyears. The high level of suicide activity of the population of the city interfaced to alcohol intake was revealed. More than 50 % were in an alcohol intoxication of various degree, among the persons prematurely left life. The share of the lethal mechanical traumas, associated with alcohol intoxication, made about a half from all cases of a mechanical trauma. During the 13-year period the decrease of the share of death resulted from cardiovascular diseases, associated with ethyl alcohol, was observed (with 30 to 16 %). Thus among the persons of young age having diseases of cardiovascular system, more than 50 % were at the time of death approach in an alcohol intoxication. The conducted research shows that the actual"hidden" losses of the population interfaced to alcohol intake, are much higher. The alcoholization of the population influences not only formation of losses from acute alcoholic poisonings, but also from the external reasons and diseases against which there was an abuse of ethyl alcohol

Recombinant Pseudomonas Vaccine: Technological Aspects of Obtaining and Evaluating Quality Indicators

For an aim to prevent Pseudomonas aeruginosa, a candidate recombinant vaccine has been developed. This vaccine – (RPV) was based on two protective proteins of P. aeruginosa: the outer membrane protein F (OprF) and the recombinant truncated form of the Exotoxin A (toxoid) that were adsorbed on the aluminum hydroxide. The optimal immunization schedule for mice included two intraperitoneal administrations with a two-week interval. RPV promoted to increase survival rates in challenged immunized mice and stimulated humoral and innate immune responses. During preclinical studies, we confirmed the immunogenicity of the vaccine that had not pyrogenicity, acute and chronic toxicity, allergenicity and immunotoxicity. Keywords: Pseudomonas aeruginosa, outer membrane protein F (OprF), toxoid, Pseudomonas Recombinant Vaccine (PRV

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

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

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.

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