[Postmortem assessment of labor from changes in the skull and brain in fetuses and newborn infants].

The paper gives data on the ways of identifying the pattern of head insertion, wire point, the degree of head flexion and extension, asynclitism, and configuration from the fetal and neonatal skull. The findings are important for the assessment of the course of labor and the quality of its management and for the diagnosis of birth injury. Emphasis is laid on the significance of brain compression in the genesis of fetal asphyxia.

[The first department of infectious diseases in Russia: history of formation, main achievements and prospects of the national infectology].

Russian first department of infectious diseases, which has great traditions and achievements, as of right is a brilliant constellation of national researchers and practitioners military infectology, not only brought the Kirov Military Medical Academy into repute, but also made a huge contribution to the development of the science of infectious diseases and the establishment of an effective system treatment and prevention of these diseases. This article outlines the main historical stages of infectology in the armed forces of our country, summed up the contribution of members of the Department of Infectious Diseases of the Military Medical Academy in medical science, marked modern progress and prospects of development of military infectology.

[Clinical and epidemiological value of adenovirus infection in the military personnel].

Adenovirus infections occur in different military groups as acute respiratory diseases combined with backsets and pneumonia. At definition of etiological structure of acute respiratory diseases in 1606 soldiers of 1-2 year of service, placed in the division of infectious diseases of the military medical academy in 2000-2011, dominance of an adenoviral infection (37.4%) was revealed, especially in non-epidemic periods of influenza (77% in 2007-2008). Adenoviral diseases among the hospitalized patients became complicated pneumonia in 17.8% of cases, and the proportion of adenoviral pneumonia in the overall community-acquired pneumonia with acute respiratory disease was 55.2%.

[HIV-infection as a risk factor of professional contamination of the military medical hospital personnel].

In Military-medical academy named by Kirov S.M., 857 HIV-infectioned patients were treated. The most part of them required in reanimation and surgical treatment, at 25.6% of patients the HIV-infection was registered in stage AIDS. More than half of cases of diseases are registered for the first time. 51.1% of patients knew about their HIV-positive status, but only 16% of patients have informed doctors. Interrogation of experts shows their low epidemiological vigilance. By calculations, registration of medical traumas occurs on the average in 7.4% of cases. There is a risk professional infection. There were defined the directions of decrease of risk of professional traumatism and infection with haemocontact infections. The algorithm of emergency chemoprophylaxis of the HIV-infection in military-medical establishment is offered.

[Comparative clinical and epidemiologic characteristic of HIV infection in women from discordant pairs].

Forty HIV-positive women living with HIV-infected sexual partner as well as 40 HIV-positive women from discordant pairs (HIV-positive wife and HIV-negative husband) were surveyed. Less than half of HIV-infected patients (40%) specified the use of condoms for sexual contacts. In the group of women living with HIV-infected partner more expressed immunosupression (CD4 count 427 cells/mcl versus 528 cells/mcl) was observed. Statistically significant increased viral load in the 1st group compared with the women from discordant pairs was revealed.

[Immunopathogenesis of viral hepatitis C. Immunological markers of the disease progression].

Results of studies of immune response during hepatitis C virus (HCV) infection were reviewed in order to reveal immunologic markers of the disease progression. Genetic heterogeneity of HCV and immunogenetic features of the host determine heterogeneity of immune response to the virus and differences in the course of the disease and outcomes. Spontaneous elimination of HCV-infection in acute phase occurs due to vigorous and sustained multispecific Th1-response toviral antigens. During such response proliferation of virus-specific CD4+ T-cells and secretion of IFN-gamma by them are observed, otherwise chronic hepatitis develops. Great importance in persistence of HCV as well as in quantitative and functional suppression of HCV-specific CD8+ T-cells has increased number of CD4+ CD25+ regulatory T-cells. Cellular immune response plays a key role not only in the elimination of HCV, but also in liver pathology associated with HCV-infection. Progression of the process and shift to its chronic form are also associated with decrease of production of IFN-gamma, alpha, IL-2 by peripheral blood mononuclear cells and increase of TNF-alpha, IFN-gamma, IL-4, IL-2r levels in blood serum.

[Motor activity of infusoria: fundamental and applied aspects].

The article considers morpho-functional organization of the cilia, locomotor organelle of the infusoria, and demonstrates the complicity of locomotor behavior of these protista. The problem of control of locomotion of infusoria is whole organism in discussed; and conclusion is drawn that system of control of movements could be multilevel and include receptor, afferent, central, efferent and effector units. In this context the macronucleus, could act as a central integrator and coordinator of the locomotor behavior being closely connected with periphery by dynamic elements of cytoskeleton. The eradication of infusoria parasitizing in humans and animals by interrupting of locomotion of the protista is also discussed.

[The condition of the stomach, duodenum and bile ducts in patients with chronic hepatitis C].

AIM: To study the status of the stomach, duodenum and biliary tracts in young patients with chronic hepatitis C. MATERIAL AND METHODS: We studied associated pathology of the gastroduodenal zone and biliary tract in 140 patients with CHC aged 16 to 35 years (mean age 25 +/- 0.8 years). We used USI and MRT of the abdominal organs, fibroesophagogastroduodenoscopy with biopsy of gastric mucosa for H. pylori, fractional duodenal tubing. 30 healthy males were controls. RESULTS: Asymtomatic gastroduodenal and biliary defects were found (75.5%). Endoscopic signs of gastroduodenal lesions were frequent (76.3%) in CHC patients, the majority of them were associated with H. Pylori and were not significantly different from those in the controls. Biliary tracts pathology, as shown by USI and MRT, occurred in 50.8%, were primarily functional (74.5%) and combined with high occurrence of bile mixed microflora with predominance of B. Fragilis (81%). Correlation of pathological changes of the gastroduodenal zone and biliary tract was established in CHC patients. How ever, they do not correlate with clinicolaboratory and histological signs of HCV infection. CONCLUSION. Young patients with CHC demonstrated no correlation between pathological changes of the gastroduodenal zone, biliary tracts and clinicolaboratory, histological signs of HCV infection. Therefore, it is recommended not to eradicate HP-infection and not to suppress opportunistic bile microflora in CHC young patients in the absence of clinical symptoms of gastrointestinal changes.

[Effect of respiratory infections on the clinical course of coronary artery disease].

The subjects of the study were 64 patients with coronary artery disease (CAD), and 38 healthy controls. The study included determination of Chlamydia pneumonia (CLPN), Toxoplasma gondii (TG), Herpes simplex virus (HSV) 1, 2, Epstein-Barr virus (EBV), and antibodies to these microorganisms. Diagnostically significant elevation of the serum levels of IgG antibodies to CLPN, HSV 1, 2, or TG was associated with CAD progression, and seropositivity to several of the agents strongly correlated with CAD progression. Moreover, the risk of future coronary events increased depending on the level of total pathogen burden. These results suggest that intracellular infectious agents are involved in the development of atherosclerosis and CAD.

[Modern medical science and Military Medical Academy].

The article presents the information about the main directions of scientific investigations of Military Medical Academy and their results during the period of 1999-2000. The scientific work was conducted in conformity with demands of orders and directives of RF Ministry of Defense. 12 integrated scientific problems were formed in the annual plans of the Academy's research work. Together with traditional directions the new ones connected with the experience of troops medical support during the armed conflicts, liquidation of consequences of extreme situations, participation of military contingents in peace-making operations were developed. The complex clinical investigations of specific features of combat pathology due to firearms used by the enemy during the military operations in Afghanistan and in the Northern Caucasus are going on. In the most of clinical departments the problems of etiology, pathogenesis and treatment of servicemen' diseases under peacetime conditions are the main directions of scientific investigations. Every year the Academy's rationalizers and inventors produce 60-70 inventions and more than 500 rationalization proposals. Since 1995 the Academy publishes the journal "Clinical medicine and pathophysiology" and since 1999--"Bulletin of Russian Military Medical Academy". The Academy's scientific potential comprises 194 professors, 295 associate professors, 349 Doctors and 894 Candidates of Science, 20 Honoured Scientists of RF, 57 members and corresponding members of academies (Russian Academy of Medical Sciences, Russian Academy of Natural Sciences and other social academies).

[The automatization of the control over the processes determining the risk of HIV-infection spreading among servicemen].

The possibilities of the control over the processes determining the HIV-infection spreading risk are considered. In the view of that the automated system which enables to evaluate risk factors predetermining the appearance of new infection cases was proposed. These factors are systematised in a multilevel database. On the basis of the statistical analysis of the risk factors situations of the spread of the HIV infection are revealed and analysed and measures for their liquidation are worked out promptly. The system is universal and can be used for the prevention of the beginning of other extreme situations caused by the spread of different infections. The examples of the comparative analysis of the risk of sexual behaviour in various groups of servicemen are given.

[Recurrent meningococcal menigitis and congenital cerebrospinal fluid rhinorrhea]. / Retsidiviruiushchii meningokokkovyi meningit i vrozhdennaia nazal'naia likvoreia.

In a 20-year old patient there were 5 relapses of meningococcus meningitis during a period of 14 years following the first illness. The development of the last relapse was atypical. A congenital cranio-nasal fistula and liquorrhea was found, inflammatory changes in the lumbar and nasal, an expressed cystic-adhesive membrane process during pneumoencephalography. Frequent relapses are connected with a congenital cranio-nasal fistula and a formation of the focus of infection in the membranes of the cerebral base.

[Early diagnosis, early therapy and prognosis of epidemic cerebrospinal meningitis]. / Ranniaia diagnostika, ranniaia terapiia i prognoz épidemicheskogo tserebrospinal'nogo meningita

The authors convened a special study for purposes of determining early signs of epidemic cerebrospinal meningitis and for the dependence of the prognosis from early etiotropic and pathogenetic therapy. On the basis of a study of 93 cases criteria of early diagnosis are being given. Unlike the data in literature, in 60.2% of the cases it was possible to initiate treatment during the first hours of the disease and in 94.6% -- not later than 48 hours. In most of the cases the disease had a grave course. Changed consciousness was observed in 55.9%, an increased amount of protein in the CSF -- in 58%. In 8 cases there was a syndrome of acute renal insufficiency. Despite these facts all the patients recovered. The authors come to the conclusion that prognosis may be significantly improved in cases of early diagnosis (during the first hours), intensive penicillin therapy (both intravenously and kanamicin into the carotid artery). The authors suggest that during reconvalescence it is feasible to prescribe resolving (pyrogenal lydase) and general therapy.

[The immunological effects of perftoran]. / Immunologichesie éffekty perftorana.

The effect of perftocarbonic emulsion-perftoran on the course of experimental lipopolysaccharide intoxication was studied in albino mice. Resistance of the animals to the endotoxin reduced 3 days after administration of 10 ml/kg of the preparation and increased 6 days after its administration. The effect of perftoran on the dynamics of some parameters of immunity and nonspecific resistance in CBA mice and guinea pigs was studied in immunodeficiency states induced by injection of 5-fluorouracil, cyclophosphamide, and irradiation. Activation of the phagocytic system occurred 3 days later, and activation of the parameters of cellular and humoral immunity 6 days later.

[Effect of perftoran on experimental hepatitis]. / Vliianie perftorana na techenie éksperimental'nogo gepatita.

The effect of perftoran on the course of experimental acute hepatitis in albino rats was studied on the hepatitis models induced by allyl alcohol or P. acnes culture with typhoid fever endotoxin. Perftoran (10 ml/kg) favored more rapid cytolytic syndrome elimination by affecting the lipid peroxidation in rat liver. The drug inhibits the activity of prooxidant enzymes (xanthine oxidase and myeloperoxidase of Kupffer cells) and induces the synthesis of factors accounting for the antiperoxidation protection in hepatocytes such as catalase, glucose-6-phosphate dehydrogenase, and reduced glutathione.

[An attempt to use ofloxacin in the treatment of acute intestinal infections]. / Opyt primeneniia ofloksatsina dlia lecheniia ostrykh kishechnykh infektsii.

The efficacy of ofloxacin in the treatment of acute intestinal infection was estimated. The trial included 31 patients: 27 with acute dysentery and 4 with salmonellosis. In all the patients the diagnosis was confirmed bacteriologically. The drug was used in a dose of 200 mg twice a day for 5 days. During the first 2 days ofloxacin was administered intravenously and during the following 3 days it was used orally. In the treatment of 3 patients with medium diseases ofloxacin was used orally during the first 3 days in a dose of 200 mg twice a day in combination with intravenous drop-wise infusion of the drug in a dose of 200 mg twice a day. In the chronic carriers ofloxacin was used in a dose of 400 mg twice a day for 5 days. Good efficacy of the drug was observed in the treatment of acute dysentery evident from the disease rapid favourable time course: by the 2nd day the body temperature lowered and the abdominal pains alleviated and by the 4th to the 6th days the stool came to the normal. Dysbiotic changes in the patients treated with ofloxacin were less pronounced by comparison with those after the treatment with other antibacterial drugs. Ofloxacin provided rapid eradication of Chlamydia in the faces and the recovery from chlamydiosis as a concomitant disease of acute dysentery in 8 patients.

[A new method physical loading tests in the evaluation of functional status and the development of rehabilitation programs for patients with acute infectious diseases]. / Novyi metod fizicheskikh nagruzochnykh prob v otsenke funksional'nogo sostoianiia i razrabotke programm reabilitatsii bol'nykh ostrymy infektsionnymi zabolevaniiami.

The authors studied the potentialities of employment of a new method of exercise tests (cyclic bicycle ergometry) for the assessment of convalescents' function and working capacity following acute communicable diseases. The above method showed the relationship of convalescents' function and working capacity with a nosological form and stage of convalescence. It was established that some indices of patients' function did not return to normal by discharge. Different mechanisms were shown to lie in the basis of disturbances in various infections. A conclusion was made that convalescents were in need of differentiated pathogenetically founded and purpose-oriented recovery therapeutic measures which should be taken into account in drawing up programs for their rehabilitation and follow-up after acute communicable diseases.

[Clinical and laboratory features of severe forms of acute viral hepatitis B]. / Kliniko-laboratornye osobennosti tiazhelykh form ostrogo virusnogo gepatita B.

AIM: To establish the clinical and laboratory features of severe forms of acute viral hepatitis B (AVHB). MATERIALS AND METHODS: 141 patients (88 males and 53 females) with different forms of the disease were examined. Among them there were 30, 33, and 78 patients with mild, moderate, and severe AVHB, respectively. In 23 patients, the course of hepatitis was complicated by acute hepatic failure; 6 of them developed hepatic coma that resulted in death. All the patients underwent comprehensive clinical and biochemical studies; some of them did a special laboratory study including immunological monitoring, determination of some parameters of lipid peroxidation (LPO) and the antioxidative system (AOS) in the blood cells, examination of blood rheological properties (by the deformability and viscosity of erythrocytic biomembranes), and determination of the level of endogenous toxemia by the content of medium molecular-weight peptides in the plasma, red blood cells, and urine. RESULTS: Pathogenetic features of severe forms of AVHB have been identified. These include: 1) a hyperimmune response to the invasion of mixed cellular and humoral virus, followed by hepatic macrophageal hyperactivation; 2) high activity of LPO with the development of AOS failure; 3) deterioration of erythrocytic rheological properties: the decreased deformability and increased viscosity of their biomembranes; 4) the maximal level of endogenous toxemia. CONCLUSION: New agents to enhance the efficiency of treatment of patients with severe AVHB should be sought in the following directions: immunomodulating, antioxidative, membrane-stabilizing, and disintoxicant ones.