Antimicrobial resistance in Neisseria gonorrhoeae isolates and gonorrhoea treatment in the Republic of Belarus, Eastern Europe, 2009-2019.

BACKGROUND: Limited antimicrobial resistance (AMR) data for Neisseria gonorrhoeae are available in Eastern Europe. We investigated AMR in N. gonorrhoeae isolates in the Republic of Belarus from 2009 to 2019, antimicrobial treatment recommended nationally, and treatment given to patients with gonorrhoea. METHODS: N. gonorrhoeae isolates (n = 522) cultured in three regions of Belarus in 2009-2019 were examined. Determination of minimum inhibitory concentrations (MICs) of eight antimicrobials was performed using Etest. Resistance breakpoints from the European Committee on Antimicrobial Susceptibility Testing were applied where available. A Nitrocefin test identified ß-lactamase production. Gonorrhoea treatment for 1652 patients was also analysed. Statistical significance was determined by the Z-test, Fisher's exact test, or Mann-Whitney U test with p-values of < 0.05 indicating significance. RESULTS: In total, 27.8% of the N. gonorrhoeae isolates were resistant to tetracycline, 24.7% to ciprofloxacin, 7.0% to benzylpenicillin, 2.7% to cefixime, and 0.8% to azithromycin. No isolates were resistant to ceftriaxone, spectinomycin, or gentamicin. However, 14 (2.7%) isolates had a ceftriaxone MIC of 0.125 mg/L, exactly at the resistance breakpoint (MIC > 0.125 mg/L). Only one (0.2%) isolate, from 2013, produced ß-lactamase. From 2009 to 2019, the levels of resistance to ciprofloxacin and tetracycline were relatively high and stable. Resistance to cefixime was not identified before 2013 but peaked at 22.2% in 2017. Only sporadic isolates with resistance to azithromycin were found in 2009 (n = 1), 2012 (n = 1), and 2018-2019 (n = 2). Overall, 862 (52.2%) patients received first-line treatment according to national guidelines (ceftriaxone 1 g). However, 154 (9.3%) patients received a nationally recommended alternative treatment (cefixime 400 mg or ofloxacin 400 mg), and 636 (38.5%) were given non-recommended treatment. CONCLUSIONS: The gonococcal resistance to ciprofloxacin and tetracycline was high, however, the resistance to azithromycin was low and no resistance to ceftriaxone was identified. Ceftriaxone 1 g can continuously be recommended as empiric first-line gonorrhoea therapy in Belarus. Fluoroquinolones should not be prescribed for treatment if susceptibility has not been confirmed by testing. Timely updating and high compliance with national evidence-based gonorrhoea treatment guidelines based on quality-assured AMR data are imperative. The need for continued, improved and enhanced surveillance of gonococcal AMR in Belarus is evident.

[INFLUENCE OF ENVIRONMENT FACTORS ON THE MORBIDITY RATE WITH TEMPORARY DISABILITY OF WORKING IN OIL REFINERY WORKERS].

There was performed a comprehensive assessment of working conditions of refinery workers on the results of the carrying out of certification of workplaces on working conditions. An analysis of the sample materials laboratory control over the content of harmful substances in the working area of industrial premises refinery. The prolonged exposure to harmful factors on the health ofworkers of the main production throughout the length of service was established to be a major riskfactor for the development of somatic and malignant diseases, to the gain in the morbidity rate and can become a cause of the emergency of malignancies.

Bone mineral density in treated at a young age for differentiated thyroid cancer after Chernobyl female patients on TSH-suppressive therapy receiving or not Calcium-D3 supplementation.

Long-term management of patients with differentiated thyroid cancer (DTC) commonly includes TSH-suppressive therapy with L-T4 and, in case of postsurgical hypoparathyroidism, Calcium-D3 supplementation, both of which may affect skeletal health. Experience with female patients treated for DTC at a young age and who were then receiving long-term therapy with L-T4 and Calcium-D3 medication is very limited to date. This cross-sectional study set out to investigate effects of Calcium-D3 supplementation and TSH-suppressive therapy on bone mineral density (BMD) in 124 young female patients treated for DTC at a mean age of 14 years and followed-up for an average of 10 years. BMD was found to be significantly higher in patients receiving Calcium-D3 medication than in patients not taking supplements. The level of ionized calcium was the strongest factor determining lumbar spine BMD in patients not receiving Calcium-D3 supplementation. Pregnancy ending in childbirth and HDL-cholesterol were associated with a weak adverse effect on spine and femoral BMD. No evidence of adverse effects of L-T4 and of radioiodine therapies on BMD was found. We conclude that Calcium-D3 medication has a beneficial effect on BMD, and that TSH-suppressive therapy does not affect BMD in women treated for DTC at young age, at least after 10 years of follow-up.

[Factors of work environment and employment of workers in production of fuels and solvents at the oil refinery].

THEME: Factors of the industrial environment and labor activity of workers of manufacture propellants and solvents at the oil refining enterprise. OBJECT OF RESEARCH: Working conditions of workers at all installations of manufacture No 1 JSC "Naftan" of Novopolotsk of Byelorussia (production of fuels and solvents). THE AIM: Hygienic evaluation of working conditions of persons working in the production of fuels and solvents at the oil refinery. METHODS: Sanitary description of the production with hygienic analysis of project design and technological documentation, qualitative and quantitative characteristics of conventional methods in the work environment and working process of employees in the workplace for the main modes of operation of the equipment. THEORETICAL AND EXPERIMENTAL RESULTS: The working environment of refineries is influenced by a number of simultaneously acting factors, which have different material nature and characteristics of the action on the human body, the workers in production of fuels and solvents at the refinery, are exposed to a variety of hazardous and dangerous factors of production, a chemical factor is prevalent, of course.

Thyroid cancer in Ukraine after the Chernobyl accident (in the framework of the Ukraine-US Thyroid Project).

As a result of the accident at the Chernobyl Nuclear Power Plant, millions of residents of Belarus, Russia, and Ukraine were exposed to large doses of radioactive iodine isotopes, mainly I-131. The purpose of the Ukraine-American (UkrAm) and Belarus-American (BelAm) projects are to quantify the risks of thyroid cancer in the framework of a classical cohort study, comprising subjects who were aged under 18 years at the time of the accident, had direct measurements of thyroid I-131 radioactivity taken within two months after the accident, and were residents of three heavily contaminated northern regions of Ukraine (Zhitomir, Kiev, and Chernigov regions). Four two-year screening examination cycles were implemented from 1998 until 2007 to study the risks associated with thyroid cancer due to the iodine exposure caused during the Chernobyl accident. A standardised procedure of clinical examinations included: thyroid palpation, ultrasound examination, blood collection followed by a determination of thyroid hormone levels, urinary iodine content test, and fine-needle aspiration if required. Among the 110 cases of thyroid cancer diagnosed in UkrAm as the result of four screening examinations, 104 cases (94.5%) of papillary carcinomas, five cases (4.6%) of follicular carcinomas, and one case (0.9%) of medullary carcinoma were diagnosed.

[Assessment of risk for occupationally induced diseases in purification plant workers at a petroleum refinery].

The risk for occupationally induced diseases was assessed in purification plant workers at a petroleum refinery. The auxiliary process (purification and prepurification plants, biochemical purification) of the refinery OAO "Naftan" was the study object. Epidemiological, sanitary-and-hygienic studies were conducted to examine the negative influence of dangerous and harmful production factors on the workers' health status. The harmful and dangerous production factors recorded at this enterprise have been found to have a negative influence on the workers' health workers, which leads to the development of occupationally induced diseases in them.

Urinary iodine concentrations in urban and rural areas around Chernobyl Nuclear Power Plant.

In 2007, we screened urinary iodine (UI) concentrations in urban (Gomel city) and in rural areas (Hoiniki city) of the Gomel Region, Republic of Belarus, which was heavily contaminated by the accident at the Chernobyl Nuclear Power Plant, in order to evaluate the current state of iodine supplementation in these areas. Median levels of UI were 220.5 microg/L (151.5-358.5) microg/L in Gomel city, and 228.0 microg/L (130.0-337.5) microg/L in Hoiniki city. Urinary concentrations in Gomel city were significantly improved, as compared to our previous results in 2000 (p<0.001). There were no differences of UI concentrations between Gomel city and Hoiniki city (p = 0.39), and none of the samples showed moderate (<50 microg/L) or severe (<20 microg/L) iodine deficiency in either city. These results suggest that the state of iodine supplementation has improved in rural areas, as well as in urban areas in the Republic of Belarus, probably due to appropriate fortification of iodized salt in this region.

[Long-term results of the use of hyperbaric oxygenation in patients with acute myocardial infarction].

Effect of hyperbaric oxygenation (HBO) on mortality and rate of development of reinfarctions during 24 month follow-up was studied in 129 otherwise conventionally treated patients with acute myocardial infarction (AMI). These patients were randomly divided into control (n=65) and intervention (n=64) groups. In the latter group treatment was supplemented with course of HBO. This course consisted of 6 HBO sessions in a single-place chamber (isopression for 40 min at working pressure 0.03 MPa o.d.) starting from day 4 - 6 of the disease. The use of HBO in combination with traditional course of drug treatment significantly reduced rate of reinfarctions (control group - 19%, intervention group - 5.3%, p < 0.05) and increased survival (control group 86.2%, intervention group 94.7%) during 2 years after hospital discharge. Maximal effect on survival was seen during first 0.5 years (91.4 and 100% in control and intervention groups, respectively, p=0.05).

Risk of thyroid cancer after exposure to 131I in childhood.

BACKGROUND: After the Chernobyl nuclear power plant accident in April 1986, a large increase in the incidence of childhood thyroid cancer was reported in contaminated areas. Most of the radiation exposure to the thyroid was from iodine isotopes, especially 131I. We carried out a population-based case-control study of thyroid cancer in Belarus and the Russian Federation to evaluate the risk of thyroid cancer after exposure to radioactive iodine in childhood and to investigate environmental and host factors that may modify this risk. METHODS: We studied 276 case patients with thyroid cancer through 1998 and 1300 matched control subjects, all aged younger than 15 years at the time of the accident. Individual doses were estimated for each subject based on their whereabouts and dietary habits at the time of the accident and in following days, weeks, and years; their likely stable iodine status at the time of the accident was also evaluated. Data were analyzed by conditional logistic regression using several different models. All statistical tests were two-sided. RESULTS: A strong dose-response relationship was observed between radiation dose to the thyroid received in childhood and thyroid cancer risk (P<.001). For a dose of 1 Gy, the estimated odds ratio of thyroid cancer varied from 5.5 (95% confidence interval [CI] = 3.1 to 9.5) to 8.4 (95% CI = 4.1 to 17.3), depending on the risk model. A linear dose-response relationship was observed up to 1.5-2 Gy. The risk of radiation-related thyroid cancer was three times higher in iodine-deficient areas (relative risk [RR]= 3.2, 95% CI = 1.9 to 5.5) than elsewhere. Administration of potassium iodide as a dietary supplement reduced this risk of radiation-related thyroid cancer by a factor of 3 (RR = 0.34, 95% CI = 0.1 to 0.9, for consumption of potassium iodide versus no consumption). CONCLUSION: Exposure to (131)I in childhood is associated with an increased risk of thyroid cancer. Both iodine deficiency and iodine supplementation appear to modify this risk. These results have important public health implications: stable iodine supplementation in iodine-deficient populations may substantially reduce the risk of thyroid cancer related to radioactive iodines in case of exposure to radioactive iodines in childhood that may occur after radiation accidents or during medical diagnostic and therapeutic procedures.

Epidemic diphtheria in Belarus, 1992-1997.

In 1990, epidemic diphtheria reemerged in Russia and spread to Belarus in 1992, when 66 cases were reported. Diphtheria cases doubled each year in 1993 and 1994 and peaked in 1995, when 322 cases were reported. Intensified routine immunization of young children and mass vaccination of older children and selected groups of adults were conducted in 1995 and were followed by mass vaccination campaigns targeting all adults in 1996. By the end of 1996, full immunization of >95% of children and coverage of>87% of adults with >/=1 dose resulted in a rapid decline in diphtheria cases. In 1998, only 36 cases of diphtheria were reported. More than 70% of the 965 cases and 26 fatalities reported during 1990-1998 occurred among persons >14 years of age. High levels of immunity among the entire population are needed for rapid control of diphtheria epidemics in the vaccine era.