[Primordial odontogenic tumor in children]. / Pervichnaya odontogennaya opukhol' u detei.

Primordial odontogenic tumor (POT) is a rare benign mixed epithelial and mesenchymal odontogenic tumor that has been included as a new nosological form in the latest classification of the World Health Organization (WHO 2017). The first two clinical cases of POT treatment in children in Russia are presented. A comprehensive examination and surgical treatment of POT were carried out. The diagnosis was confirmed morphologically. OBJECTIVE: To inform maxillofacial surgeons and dentists about the clinical, radiological and morphological features of POT on the example of clinical experience and literature data.

[Rationale for choosing an antibiotic for the treatment of cystitis: recommendations of clinical pharmacologists: A review].

In recent years, the harmonization of domestic and foreign clinical recommendations for the treatment of cystitis has been achieved. Nitrofurans and fosfomycin trometamol are recommended as first line therapy antibiotics, and oral 3rd generation of cephalosporins are recommended as alternative antibiotics; fluoroquinolones are excluded from the recommended medications due to an unfavorable safety profile. The main rationale for inclusion of antibiotics in the recommendations as a first line therapy of cystitis is the level of resistance of uropathogens to antibiotics, primarily Escherichia coli. Stable low level of resistance of E. coli in Russia was noted to nitrofurans and fosfomycin (5%), higher to cephalosporins. Among nitrofurans, furazidine is characterized by higher activity against E. coli compared to nitrofurantoin. The potassium salt of furazidine in dosage form with magnesium carbonate is preferred, since it is characterized by higher bioavailability and provides a therapeutic level of concentrations in urine above the MIC during the entire dosing period. Due to the global increase in the resistance of uropathogens observed in recent years, experts have begun to pay more and more attention to the ecological safety of antimicrobial therapy in order to minimize the risk of concomitant (collateral) damage, contributing to the selection of multi-drug resistant strains of microorganisms. In the latest WHO document of 2021, experts divided antibiotics into three groups (ACCESS, WATCH, RESERVE) according to the priority of choice. The ACCESS group of drugs for the treatment of cystitis includes nitrofurantoin and furazidine as agents with minimal collateral effect, while fosfomycin trometamol and cephalosporins are listed in the WATCH group. Thus, from the standpoint of ecological safety, WHO experts recommend prescribing nitrofurans in the treatment of cystitis in the first line of therapy.

Intelligent Decision-Support System for Epidemiological Diagnostics. II. Information Technologies Development*, *.

The article projects the components of the intelligent decision support system for epidemiological diagnostics and investigates their interaction with the user. The system includes a bank of models and machine learning methods, a bank of population dynamics models, visualization and reporting tools, and management decision-making unit. The concept of information technology to ensure biosafety of the population is provided. A model of specified information technology use cases is developed and a sequence diagram is constructed. A model of information technology components and ways of their deployment on a server are proposed.

Intelligent Decision-Support System for Epidemiological Diagnostics. I. A Concept of Architecture Design.

The problems of decision support for epidemiological diagnostics are investigated. The basis for supporting decision-making is mathematical tools for analyzing morbidity data, as well as modeling of epidemic processes. The current state of research in this area is analyzed. The features of decision-making in epidemiology and public health are formalized. Principles for the development of an intelligent information system for decision-making support for epidemiological diagnostics are proposed. A systemic model of the system, a model of the interaction of elements of the epidemiological diagnostics system and the interaction of logical components of the information system has been developed. Taking into account the identified features of these processes, the concept of the architecture of such an intelligent information system is proposed.

[Primordial odontogenic tumor is a new nosological entity in the 2017 WHO classification of Head and Neck Tumors]. / Pervichnaya odontogennaya opukhol' ­ novaya nozologicheskaya edinitsa v klassifikatsii VOZ opukholei golovy i shei (2017).

The paper describes a case of primordial odontogenic tumor of the mandible, a rare neoplasm that has been recently included into the WHO classification. It presents its clinical, radiological, morphological, and immunohistochemical characteristics.

[Rationale for the choice of an antibiotic for urinary tract infections with an emphasis on the environmental safety of therapy].

Difficulties in prescribing antibiotics for lower urinary tract infections (UTI) are associated with a fact that such patients can be treated not only by urologists, but also by general practitioners, internists, pediatricians, and gynecologists. Therefore, it is important to adapt the practical recommendations for the treatment of cystitis for different medical disciplines. When creating clinical guidelines, experts take into account the different factors in choosing antibiotic therapy. First of all, pharmacokinetics is of importance and drugs with renal excretion should be preferred. Secondly, the natural activity of the antibiotic against the pathogens, which cause cystitis, has to be considered. In uncomplicated infections, E. coli predominates, while in complicated and recurrent infections E. coli and other enterobacteria are commonly isolated, as well as Enterococci. In addition, local resistance pattern is reviewed. In the Russian Federation E. coli has minimal resistance to nitrofurans and fosfomycin. Lastly, antibiotics can negatively affect the gastrointestinal and urinary tract microbiota and contribute to the increase of antibiotic resistance and the selection of antibiotic-resistant strains, therefore the environmental safety of therapy should be considered. The effect of antibiotics on the resident flora of the gastrointestinal tract, urinary tract and vagina is called collateral effect, or concomitant (parallel) damage, and it may exceed the therapeutic effect of some antibiotics. Cephalosporins and fluoroquinolones can cause ecologically unfavorable effects with the risk of selection of resistant strains; therefore, these drugs are currently considered as second-line agents for UTI. When choosing an antibiotic, preference should be given to drugs with the narrow spectrum and minimal collateral damage, i.e., the principle of "minimum sufficiency" is of importance. Nitrofurans and fosfomycin trometamol are the optimal drugs in terms of efficiency and environmental safety in UTI. WHO experts consider nitrofurans as the most environmentally safe antibiotics with a minimally sufficient spectrum of activity. The environmental safety of antimicrobial therapy is an important component of preventing antibiotic resistance at the global and local levels.

Abscess of the spleen in a patient with infectious endocarditis.

A patient with infective endocarditis (IE), complicated by the development of the abscess of the spleen, is described. The diagnosis of IE was verified several months after the onset of clinical symptoms (fever, hemorrhagic skin rashes, splenomegaly).The patient suspected hemorrhagic vasculitis and lymphoma of the spleen, which were not confirmed. With transesophageal echocardiography, vegetations on the aortic valve have been identified, and, according to CT, a spleen infarct with suspected abscess. A successful simultaneous operation was performed - aortic valve replacement and splenectomy. An abscess was found in the spleen. The patient is discharged in a satisfactory condition.

Infection in the clinic of internal diseases.

In the modern clinic of internal diseases, the specific gravity of the infectious pathology, manifested by various clinical syndromes, is increasing. Infectious pathology is represented by diseases of the respiratory system, heart disease (infective endocarditis, cardioimplant infections, viral myocarditis), infectious arthropathies, extrahepatic manifestations of viral hepatitis, cytopenic syndromes, various manifestations of sepsis and some other conditions.In most cases, the diagnosis and management of such patients is the responsibility of the internist, who must be able to suspect the infection and carry out its verification. In the process of diagnostic search and management of patients, close interaction of the internist with a clinical microbiologist, clinical pharmacologist and other related specialists is necessary.

[Results of the medical support for the international army games "ArMI-2016" and the international-military-technical forum "Army 2016"].

Results of the medical support for the international army games <> and the international military-technical forum <>. It sets out the organizational and methodical bases of medical support massive military-patriotic and cultural events. Obtained its main stages and given their characteristics. The leading role of planning in the organization of medical support measures is presented. The basic disadvantages and the main directions of improving the quality and efficiency of the medical support of public events with the participation of troops are defined.

[Organization of sanitary anci aviation evacuation in ine Armea rorces].

The current state is examined and the organizational experience of the sanitary and aviation evacuation is analyzed, as well as the equipment for carrying out the evacuation. The problematic issues of the organization of sanitary, aviation evacuation are identified, and prospective directions of its development and improvement in the Armed Forces in peacetime are outlined.

Multicentre Study of the Prevalence and Clinical Value of Hospital-Acquired Infections in Emergency Hospitals of Russia: ERGINI Study Team.

BACKGROUND: Hospital-acquired infection (HAI) is a common problem in intensive care units (ICU) and other hospital units. The methodical system of surveillance of hospital-acquired infections (HAI) is not available in Russia and there is no reliable data about the prevalence or epidemiology of HAI. We aimed in this pioneer study to determine the prevalence, epidemiological and microbiological characteristics, risk factors, clinical value and outcomes of HAI in different units of emergency multifields hospitals of Russia. METHODS: This prospective multicentre 1-day prevalence study with 28-days follow-up was realized between January and May 2013. Thirty two emergency hospitals with more than 500-beds from 18 cities participated in this study. The study was conducted separately on 5 different days in ICU, therapeutic, surgical, urology and neurology units. All patients treated in the unit on the day of the study were examined for the presence of HAI according to CDC criterias. Risk factors of HAI, nosological and etiological structure, susceptibility of pathogens were also evaluated. RESULTS: Totally 3809 patients were included in the study during 5 days of investigation in ICU and therapeutic, surgical, urology and neurology units (respectively 449, 1281, 1431, 342 and 306 patients). The total number of registered HAI was 290 and the prevalence of HAI was 7.61% (95% CI 6.81%, 8.50%). The greatest rate of HAI was registered in ICU (26.28%) and neurological unit (13.73%); the rate was lower in therapeutic, surgical and urology units (4.76, 4.12 and 2.92%). The prevalence of HAI.was similar in adult and pediatric hospitals .(7.62 and 7.54%). The prevalence of community-acquired infections was 28.53%. The lower respiratory tract was the most common site of infection, accounting for 42.4%.of HAIs followed by the urinary tract (19.0%), skin and soft tissue (13.4%), abdomen (11.4%) and intravascular (4.8%). 311 pathogens were isolated: 58.8% of isolates were gram-negative, 32.8% gram-positive, and 8.4% Candida spp. The most common bacterial isolates were Klebsiella spp. (19.6%), E.coli (12.2%), S.aureus (11.3%), Acinetobacter spp. (10.9%), E.faecalis (7.4%) and P.aeruginosa (7.1%). The resistance rate of E.coli and Klebsiella spp. to 3rd generation of cephalosporins was 60.5 and 95.1%. Only 26.5% of Acinetobacter isolates and 59,1% of P.aeruginosa isolates were susceptible to imipenem. The MRSA rate was 48.6%; 17,4% of E.faecalis were resistant to ampicillin. The mortality rate was higher in patients with HAI (16.5%) than in patients without HAI (3.0%); the mean length of hospital stay was also higher in patients with HAI (24.6±11,4 vs. 16.2±15,3 days). CONCLUSION: The prevalence of HAI in Russian hospitals is high. According to the prevalence data the estimating annual number of HAI in Russia is approximately 2,300,000 cases. The multi-drug resistant microorganisms were dominated among causative agents of HAI.

[Equipment of field units of the medical service of the Armed Forces with modern medical complexes on the basis of pneumo-frame modules, and procedure of the use].

Equipment of field units or ine meaical service of the Armed Forces with modem medical complexes on the basis of pneumo-frame modules, and procedure of the use. On the basis of experience of medical supply in local wars and modern armed conflicts, when liquidating medical and sanitary disaster consequences the authors revealed the main organizational problems in army echelon of the medical service. It is shown that these problems can be solved by means of deployment of medical units and subunits. Requirements for means of deployment are defined. Present organic equipment is assessed. The authors showed advantages ofpneumo- framed modules, their tactic and technical characteristics, variants of the use when deploying army levels of field medical evacuation.

Ertapenem versus cefepime for initial empirical treatment of pneumonia acquired in skilled-care facilities or in hospitals outside the intensive care unit.

The study presented here compared the efficacy and safety of ertapenem and cefepime as initial treatment for adults with pneumonia acquired in skilled-care facilities or in hospital environments outside the intensive care unit (ICU). Non-ventilated patients developing pneumonia in hospital environments outside the ICU, in nursing homes, or in other skilled-care facilities were enrolled in this double-blind non-inferiority study, stratified by APACHE II score (15) and randomized (1:1) to receive cefepime (2 g every 12 h with optional metronidazole 500 mg every 12 h) or ertapenem (1 g daily). After 3 days of parenteral therapy, participants demonstrating clinical improvement could be switched to oral ciprofloxacin or another appropriate oral agent. Probable pathogens were identified in 162 (53.5%) of the 303 randomized participants. The most common pathogens were Enterobacteriaceae, Streptococcus pneumoniae, and Staphylococcus aureus, isolated from 59 (19.5%), 39 (12.9%), and 35 (11.6%) participants, respectively. At the test-of-cure assessment 7-14 days after completion of all study therapy, pneumonia had resolved or substantially improved in 89 (87.3%) of 102 clinically evaluable ertapenem recipients and 80 (86%) of 93 clinically evaluable cefepime recipients (95% confidence interval for the difference, -9.4 to 11.8%), fulfilling pre-specified criteria for statistical non-inferiority. The frequency and severity of drug-related adverse events were generally similar in both treatment groups. In this study population, ertapenem was as well-tolerated and efficacious as cefepime for the initial treatment of pneumonia acquired in skilled-care facilities or in hospital environments outside the ICU.

[Coamoxiclav in the empirical monotherapy in outpatients with community acquired pneumonia]. / Amokcitsillin/klavulanat kaliya v 'empiricheskol monoterapii u ambulatornykh bol'nykh.

Amoxyclav (amoxycillin/potassium clavulanate, A/PC) was used in a dose of 625 mg 3 times a day in the treatment of 68 outpatients at the age of 17 to 88 years (the average age of 49 years) with slight or moderate community-acquired pneumonia. In 49 per cent of the patients the pneumonia developed at the background of concomitant chronic diseases. The positive clinical effect was observed in 94 per cent of the patients. In 76 per cent of them a short-term treatment course of 5 days was sufficient. Before the treatment 91.8 per cent of the isolates proved to be susceptible to A/PC. The pathogen eradication after completion of the treatment was stated in 72 per cent of the cases. Moderate gastrointestinal adverse reactions developed in 4 patients (6 per cent). The results demonstrated high clinical and bacteriological efficacies of A/PC and made it possible to recommend the drug as the 1st class agent for the initial empirical therapy of community-acquired pneumonia in outpatients.