БРЮШНОЙ ТИФ С ЛЕТАЛЬНЫМ ИСХОДОМ У ЛЮДЕЙ С ВЫРАЖЕННОЙ ТРОФОЛОГИЧЕСКОЙ НЕДОСТАТОЧНОСТЬЮ ОРГАНИЗМА В ЭКСТРЕМАЛЬНЫХ УСЛОВИЯХ

For purpose of clinical and morphological characterization of typhoid fever with fatal outcome was perform analysis of medical documentation as well as postmortem studies of internal tissues in 36men aged 21 to 34 years with severe body weight loss and in the conditions of combat stress in period from 1983 to 1985. The results of the study find a number of clinical and pathomorphological features of typhoid fever in patients with body weight deficiency that were in extreme conditions. Focal changes of the central nervous system were detected. The defeat of the respiratory system was characterized from the first days of the disease by bronchitis, and in the subsequent development of pneumonia, plevritis and empyema of the pleura. Majority of patients had symptoms of cardiovascular and renal failure. In died in the first week of the disease and in 2/3 parts – in a later period were combined with the symptoms of infectious-toxic encephalopathy and severe acute respiratory failure. All died had postmortem dystrophic changes of cardiomyocytes, and in patients had fatal outcome in 2–5 weeks – also focal or diffuse myocarditis. In a third of the patients who died, the disease was complicated by intestinal perforations. In a number of cases, peritonitis was a consequence of necrosis of mesenteric lymph nodes. In all patients with a fatal outcome, hemorrhagic (thrombohemorrhagic) syndrome was diagnosed. A significant proportion of patients posthumously detected signs of sepsis and other complications, many of which could be the cause of death.С целью клинической и морфологической характеристики брюшного тифа с летальным исходом у людей с гипотрофией организма, находившихся в экстремальных условиях, проведен анализ медицинской документации, а также посмертных исследований тканей внутренних органов у 36 мужчин в возрасте 21–34 лет, страдавших выраженным дефицитом массы тела и находившихся сравнительно продолжительное время в условиях связанного с боевыми действиями стресса в период с 1983 по 1985 г. Результаты проведенного исследования позволили установить ряд клинических и патоморфологических особенностей брюшного тифа у пациентов с дефицитом массы тела, находившихся в экстремальных условиях. Выявлялись очаговые изменения центральной нервной системы. Поражение органов дыхания характеризовалось с первых дней болезни бронхитом, а в последующем – развитием пневмонии, плеврита и эмпиемы плевры. У большинства больных наблюдались симптомы сердечно-сосудистой и почечной недостаточности. У умерших на первой неделе болезни и у 2/3 больных – в более поздний период они сочетались с симптомами инфекционно-токсической энцефалопатии и резко выраженной острой дыхательной недостаточности. У всех умерших посмертно выявлены дистрофические изменения кардиомиоцитов, а с летальным исходом на 2–5-й неделях – также очаговый или диффузный миокардит. У трети умерших больных заболевание осложнялось кишечными перфорациями. В ряде случаев перитонит был следствием некроза мезентериальных лимфоузлов. У всех пациентов с летальным исходом посмертно диагностирован геморрагический (тромбогеморрагический) синдром, который почти всегда был резко выраженным и относительной часто служил непосредственной причиной смерти. У значительной части больных посмертно обнаружены признаки сепсиса и других осложнений, многие из которых могли быть самостоятельно причиной летального исхода

First results of the Kourovka Planet Search: discovery of transiting exoplanet candidates in the first three target fields

We present the first results of our search for transiting exoplanet candidates as part of the Kourovka Planet Search (KPS) project. The primary objective of the project is to search for new hot Jupiters which transit their host stars, mainly in the Galactic plane, in the $R_c$ magnitude range of 11 to 14 mag. Our observations were performed with the telescope of the MASTER robotic network, installed at the Kourovka astronomical observatory of the Ural Federal University (Russia), and the Rowe-Ackermann Schmidt Astrograph, installed at the private Acton Sky Portal Observatory (USA). As test observations, we observed three celestial fields of size $2\times2$ deg$^2$ during the period from 2012 to 2015. As a result, we discovered four transiting exoplanet candidates among the 39000 stars of the input catalogue. In this paper, we provide the description of the project and analyse additional photometric, spectral, and speckle interferometric observations of the discovered transiting exoplanet candidates. Three of the four transiting exoplanet candidates are most likely astrophysical false positives, while the nature of the fourth (most promising) candidate remains to be ascertained. Also, we propose an alternative observing strategy that could increase the project's exoplanet haul.Comment: 11 pages, 16 figures; Accepted for publication in Monthly Notices of the Royal Astronomical Society 201

Эпидемиологические и фармакоэкономические аспекты ВИЧ-инфекции у военнослужащих

The goals of the research are to determine the latent morbidity and financial losses of the Russian Ministry of Defense due to the dismissal of service members with HIV infection at symptomatic stages; to establish the supposed clinical and pharmacoeconomic effectiveness of the early detection and treatment of service members.The materials compile 379 case histories of patients of the only specialized department for HIV-positive military personnel in the Armed Forces for 2017–2019, as well as various reporting forms. The study uses the following methods for the analysis: Markov chains are employed to calculate QALYs (Quality Adjusted Life Years), “cost-effectiveness”, and “willingness to pay”. The research compares two competitive models: “Current Situation” - without the introduction of algorithms for early detection and treatment of HIV infection, and “Prognosis” - with the introduction of these algorithms.The following results are obtained: implementing a mandatory triennial screening for HIV-antibodies among military personnel allows to raise the detection of HIV-positive military personnel in the early stages of the disease by 55%. At the same time, early administered antiretroviral therapy prevents the progression of HIV infection, while the number of military personnel who have reached symptomatic stages of HIV infection and the number of deaths decreases by 35,6% and 80,2% (six-fold), respectively. The economic effectiveness of these measures includes a reduced cost of treatment and an increased length of military service. The sensitivity analysis of the method shows that the proposed measures remain pharmacoeconomically highly effective with a wide variability of the initial data.Conclusion. The results of the study demonstrate that a significant improvement of the epidemiological situation in the field of HIV infection in the Armed Forces is achievable at very low economic costs. With the full implementation of the proposed measures, the cohort of military personnel of the Armed Forces is able to achieve the World Health Organization’s “90-90-90”criteria of in 3–5 years.Цель: определение скрытой заболеваемости и финансовых потерь Минобороны России вследствие увольнения военнослужащих с ВИЧ-инфекцией в стадии вторичных заболеваний, а также установление предполагаемой клинической и фармакоэкономической эффективности мероприятий по раннему выявлению и лечению военнослужащих.Материалы составили 379 историй болезни пациентов единственного в Вооруженных силах специализированного отделения для ВИЧ-позитивных военнослужащих за 2017–2019 гг., а также различные формы отчетности. Для анализа использованы следующие методы: Марковское моделирование процесса позволило определить QALY (Quality Adjusted Life Years – годы жизни с поправкой на качество) и провести фармакоэкономический анализ «Затраты – эффективность» и «Порог готовности платить». Сравнивались две конкурентные модели, названные «Актуальная ситуация» – без введения алгоритмов раннего выявления и лечения ВИЧ-инфекции и «Прогноз» – при введении указанных алгоритмов.Результаты: введение обязательного периодического лабораторного обследования 1 раз в 3 года для военнослужащих по контракту позволит увеличить на 55% выявление ВИЧ-позитивных военнослужащих на ранних стадиях заболевания. При этом раннее назначение антиретровирусной терапии позволит предупредить прогрессирование ВИЧ-инфекции, число военнослужащих, достигших стадии 4 ВИЧ-инфекции, снизится на 35,6%, а число летальных исходов – на 80,2% (в 6 раз), что обеспечит существенную экономическую эффективность за счет снижения стоимости лечения и увеличения длительности военной службы. Анализ чувствительности метода показал, что предложенные мероприятия остаются фармакоэкономически высокоэффективными при широкой вариативности исходных данных.Заключение. По результатам проведенного исследования показано, что существенное улучшение эпидемиологической обстановки в области ВИЧ-инфекции в Вооруженных силах достижимо при очень малых экономических затратах. При полноценной реализации предложенных мероприятий когорта военнослужащих Вооруженных сил Российской Федерации способна достичь критериев Всемирной организации здравоохранения «90-90-90» уже через 3–5 лет

Interrelations between viral load and cellular immunity in patients with COVID-19 of varying severity

Assessment of viral load levels in various biological samples taken from the respiratory tract can be an indicator of an ongoing process of active viral replication and may be used to monitor severe respiratory viral infections. The study of the relationship between SARS-CoV-2 viral load and immunological laboratory parameters is an important step in the search for clinical markers of COVID-19.The aim of this research was to quantify viral load in patients with COVID-19 and to identify the relation-ship between viral load and changes in the parameters of the cellular component of the immune system.A laboratory examination was carried out on 74 patients diagnosed with COVID-19, they were divided into 3 groups based on the severity of the disease: mild, moderate, severe. Total viral load in clinical samples was determined by the number of SARS-CoV-2 RNA copies per 100 copies of the reference RNaseP gene.     A comprehensive assessment of the cellular component of the immune system was performed using flow cytometry and direct monoclonal antibodies, and the IL-6, and C-reactive protein concentrations were determined.We revealed a relationship between the development of serious clinical conditions in the patients with COVID-19, and the levels of viral load. High levels of viral RNA in biological samples correlate with main indicators of the T cell component of the immune system associated with disease severity. In a subgroup of patients with an extremely high viral load, strong positive correlations were found between the relative numbers of cytotoxic lymphocytes (CD3+CD8+), activated T lymphocytes (CD3+HLA-DR+), as well as absolute and relative numbers of activated B lymphocytes and NK cells (CD3-CD25+).Laboratory monitoring of the cellular component of the immune system, along with the assessment of viral loads, should improve  early assessment of clinical condition in the patients with COVID-19. Changes   in expression levels of activation markers on immune cells can be potentially viewed as indicators of recovery during COVID-19

Spin physics with antiprotons

New possibilities arising from the availability at GSI of antiproton beams, possibly polarised, are discussed. The investigation of the nucleon structure can be boosted by accessing in Drell-Yan processes experimental asymmetries related to cross-sections in which the parton distribution functions (PDF) only appear, without any contribution from fragmentation functions; such processes are not affected by the chiral suppression of the transversity function $h_1(x)$. Spin asymmetries in hyperon production and Single Spin Asymmetries are discussed as well, together with further items like electric and magnetic nucleonic form factors and open charm production. Counting rates estimations are provided for each physical case. The sketch of a possible experimental apparatus is proposed.Comment: Presented for the proceedings of ASI "Spin and Symmetry", Prague, July 5-10, 2004, to be published in Czech. J. Phys. 55 (2005

Modern Approaches to the Diagnosis and treatment of <i>Clostridioides difficile (C. difficile)</i>-associated Disease in Adults (literature Review and Expert Council Resolution)

Aim: to review the modern approaches to the diagnosis and treatment of C. difficile-associated disease in adults and present the resolution of the Expert Council held on March 25, 2023 in Moscow.General provisions. C. difficile is the most important nosocomial pathogen which spores are also commonly found in the environment. Microbiota impairment, primarily due to the use of antibacterial drugs, is a key stage in the development of C. difficile-associated disease. A search for an infection should be carried out only in patients with diarrhea, and it is advisable to use at least 2 laboratory methods. The drug of choice for first-line treatment is vancomycin. If drug treatment is ineffective or the patient has recurrent clostridial infection, fecal microbiota transplantation should be considered. The probiotic strain Saccharomyces boulardii CNCM I-745 has a direct inhibitory effect on C. difficile toxin A, promotes normalization of the intestinal microbiota composition, and decreases the inflammatory reaction in colonic mucosa colonized with a toxigenic strain of C. difficile.Conclusions. Addition of the probiotic strain Saccharomyces boulardii CNCM I-745 to antibacterial therapy promotes both primary and secondary prevention of C. difficile-associated disease

Diagnosis and Treatment of Irritable Bowel Syndrome: Clinical Recommendations of the Russian Gastroenterological Association and Association of Coloproctologists of Russia

Aim. Current clinical recommendations accentuate current methods for the diagnosis and treatment of irritable bowel syndrome (IBS).Key points. IBS is a functional bowel disorder manifested with recurrent, at least weekly, abdominal pain with the following attributes (any two leastwise): link to defecation, its frequency or stool shape. The symptoms are expected to persist for at minimum three months in a total six-month follow-up. Similar to other functional gastrointestinal (GI) disorders, IBS can be diagnosed basing on the patient symptoms compliance with Rome IV criteria, provided the absence of potentially symptom-causative organic GI diseases. Due to challenging differential diagnosis, IBS can be appropriately established per exclusionem, with pre-examination as follows: general and biochemical blood tests; tissue transglutaminase IgA/IgG antibody tests; thyroid hormones test; faecal occult blood test; hydrogen glucose/ lactulose breath test for bacterial overgrowth; stool test for enteric bacterial pathogens and Clostridium difficile A/B toxins; stool calprotectin test; abdominal ultrasound; OGDS, with biopsy as appropriate; colonoscopy with biopsy. The IBS sequence is typically wavelike, with alternating remissions and exacerbations often triggered by psychoemotional stress. Treatment of IBS patients includes dietary and lifestyle adjustments, various-class drug agents prescription and psychotherapeutic measures.Conclusion. Adherence to clinical recommendations can facilitate timely diagnosis and improve medical aid quality in patients with different clinical IBS variants

ЭЛИМИНАЦИЯ HCV-ИНФЕКЦИИ: ИСТОРИЯ С ПРОДОЛЖЕНИЕМ

Chronic hepatitis C remains one of the most important socially significant infections for world health. The use of modern highly effective drugs with direct antiviral action allows to achieve a sustained virological response in patients. At the same time, in a significant number of cases after elimination of HCV infection, the progression of fibrosis continues with the development of its terminal stages and an unfavorable outcome for patients. The article focuses on comorbid pathology, which is a leading factor in this process in patients with chronic hepatitis C who have achieved a sustained virological response and presenting a serious challenge to modern hepatology.Хронический гепатит С остается одной из актуальных для мирового здравоохранения социально значимых инфекций. Использование современных высокоэффективных препаратов с прямым противовирусным действием позволяет достичь устойчивого вирусологического ответа у пациентов. В то же время в значительном количестве случаев после элиминации HCVинфекции продолжается прогрессирование фиброза с развитием его терминальных стадий и неблагоприятного исхода для пациентов. В настоящей статье обсуждается роль коморбидной патологии, являющейся ведущим фактором в этом процессе у пациентов с хроническим гепатитом С, достигших устойчивого вирусологического ответа, и представляющей серьезный вызов для современной гепатологии

The COMPASS Experiment at CERN

The COMPASS experiment makes use of the CERN SPS high-intensitymuon and hadron beams for the investigation of the nucleon spin structure and the spectroscopy of hadrons. One or more outgoing particles are detected in coincidence with the incoming muon or hadron. A large polarized target inside a superconducting solenoid is used for the measurements with the muon beam. Outgoing particles are detected by a two-stage, large angle and large momentum range spectrometer. The setup is built using several types of tracking detectors, according to the expected incident rate, required space resolution and the solid angle to be covered. Particle identification is achieved using a RICH counter and both hadron and electromagnetic calorimeters. The setup has been successfully operated from 2002 onwards using a muon beam. Data with a hadron beam were also collected in 2004. This article describes the main features and performances of the spectrometer in 2004; a short summary of the 2006 upgrade is also given.Comment: 84 papes, 74 figure