[Acute bronchitis - modern possibilities of mucactive therapy].

AIM: Analysis of the clinical effectiveness and safety of erdosteine use in comparison with standard (real practice) mucoactive therapy in patients with acute bronchitis (АВ) in adults. MATERIALS AND METHODS: The observational program included 100 adult patients with АВ, 50 of them (group 1) received erdosteine, the group 2 also included 50 patients who received acetylcysteine, bromhexine and other mucolytics (real clinical practice). The following were assessed: cough severity, average time for resolution of night and daytime cough, satisfaction with treatment, NO concentration in exhaled air, levels of C-reactive protein (CRP) and interleukin-6 (IL-6). RESULTS: The average duration of relief of severe daytime cough requiring continued therapy was: in group 1 - 3.7±0.46 days, night cough - 1.14±0.94 days. In the second group, daytime cough was relieved in 3.8±0.4 days, night cough - 1.08±0.7 days. The duration of mucoactive therapy in group 1 was 5.32±0.82 days, in group 2 this figure was 8.5±1.4 days (p<0.05). The number of АВ patients with a significant reduction in the severity of productive cough (1 point on cough severity scale) on the 6th day from the beginning of treatment in group 1 (erdosteine) amounted to 32 (64%), in group 2 - 27 (54%). Satisfaction with the treatment was higher in the group receiving erdosteine: according to the indicators "very satisfied" and "extremely satisfied" the patients of the group 1 - 42 - were the leaders in comparison with the group 2, where these positions were marked by 28 patients. The level of CRP in patients with АВ in group 1 was 24.7±21.24 mg/l, in group 2 - 16.37±16.5 mg/l, which indicates the viral etiology of the process and no need in the prescription of antimicrobial drugs. For the first time in Russian practice, the following were determined: the level of IL-6, which in the group 1 was 10.3±6.7 pc/ml; in the group 2 - 10.03±3.94 pc/ml; the level of exhaled NO in group 1 was 16.5±5.1 ppb, in group 2 - 14.9±4.6 ppb (the norm is up to 25 ppb). These indicators, against the background of mucoactive therapy, decreased to normal values by 6th day. CONCLUSION: The findings expand our understanding of АВ in adults. New results have been obtained on the role of CRP, IL-6 and NO in exhaled air during АВ. The use of erdosteine was accompanied by a significant mucoactive effect in the form of a pronounced regression of cough in patients with АВ compared to the comparison group in shorter term.

[Evaluation of the efficacy and safety of a combination drug containing ambroxol, guaifenesin, and levosalbutamol versus a fixed-dose combination of bromhexine/guaifenesin/salbutamol in the treatment of productive cough in adult patients with acute bronchitis].

AIM: To evaluate the efficacy and safety of a combination drug containing ambroxol, guaifenesin, and levosalbutamol, oral solution, versus Ascoril Expectorant, syrup (combination of bromhexine, guaifenesin, and salbutamol) in the treatment of productive cough in adult patients with acute bronchitis. MATERIALS AND METHODS: This open-label, randomized, phase III study included patients with acute bronchitis who had a productive cough with difficulty in sputum expectoration. 244 patients were randomized in a 1:1 ratio and received 10 mL of the study drug or reference drug 3 times daily for 2 weeks. After 7 and 14 days of treatment, the physician evaluated patient's subjective complaints and the efficacy of therapy. The primary endpoint was the proportion of patients with high and very high efficacy. RESULTS: The primary endpoint was reached by 70 (0.5738) patients in the study drug group and 54 (0.4426) in the reference drug group (p=0.04). The intergroup difference was 0.1311 [95% confidence interval: 0.0057; 0.2566]. The lower limit of the 95% confidence interval was above zero, which confirms the superiority of therapy with the study drug over therapy with Ascoril Expectorant. The proportion of patients with a 1-point total score reduction and with complete resolution of all symptoms according to the Modified Cough Relief and Sputum Expectoration Questionnaire after 7 and 14 days was numerically higher in the study drug group versus the reference drug group. There were no statistically significant differences between the groups in the incidence of adverse events. CONCLUSION: The efficacy of a new combination drug containing ambroxol, guaifenesin, and levosalbutamol in the treatment of productive cough in adult patients with acute bronchitis is superior to the efficacy of Ascoril Expectorant. The safety profiles of the study drug and the reference drug were comparable.

[Eating behavior in children with autism spectrum disorder]. / Narusheniya pishchevogo povedeniya u detei s rasstroistvami autisticheskogo spektra.

OBJECTIVE: To study atypical eating behavior (AEB) in various variants of autism spectrum disorder (ASD) to determine the prognosis and therapeutic tactics. MATERIAL AND METHODS: One hundred and eighty patients (110 girls, 70 boys), aged 2 to 5 years (mean age 4 years), with a diagnosis of «Childhood autism¼ (F84.02), «Atypical autism¼ (F84.1), «Asperger Syndrome¼ (F84.5) and the presence of AEB were examined. RESULTS: Three clinical variants of ASD accompanied by AEB were identified: catatonic-regressive (n=75, 41%), catatonic (n=81, 45%) and hyperdynamic (n=24, 13%). The most pronounced AEB were in the catatonic-regressive variant, and the least in the hyperdynamic variant of ASD. The severity of AEB is associated with the severity of cognitive dysontogenesis. CONCLUSION: The characteristics of AEB are associated with the leading clinical syndrome of ASD. The severity of catatonia and regression affects the depth of AEB, which leads to secondary somatic disorders. Specialists of various profiles should participate in medical work for successful rehabilitation and prevention of somatic complications.

[The integral estimation of health problems and effectiveness of stage rehabilitation in patients after ischemic stroke]. / Integral'naia otsenka narushenii zdorov'ia i éffektivnosti étapnoi reabilitatsii bol'nykh posle ishemicheskogo insul'ta.

The multidisciplinary assessment of health problems after stroke should take into account not only motor, speech disorders, disability, but also postural balance, type and level of mental disorders, degree of working hand dysfunctions, cortical motor neuron functional indicators, and risk factors for recurrent stroke. OBJECTIVE: To develop a methodology for the integrated assessment of health problems and the effectiveness of stage rehabilitation in patients after ischemic stroke (IS) and risk factors for recurrent stroke. MATERIAL AND METHODS: Examinations were made in 101 patients (mean age 59.78±8.63 years) after IS in the middle cerebral arterial bed in the early recovery period. Of them, 62 patients were examined in the early and late recovery periods of stroke. The investigators assessed neurological disorders using National Institutes of Health Stroke Scale (NIHSS), Ashworth Spasticity Scale, dysarthria scale, Medical Research Council Scale and wrist dynamometry, Frenchay Arm Test), Self-Care Rating Scale (Barthel index) and social and living activities (Rehabilitation Activities Profile Scale), psychological status (procedures of Memory for Pictures and Ten Words, Schulte-Platonov Tables, Luscher Color Test, Hospital Anxiety and Depression Scale (HADS), Recovery Locus of Control Scale) questionnaire, functional (stabilography, transcranial magnetic stimulation) and laboratory (lipid profile test) results. The integrated assessment of health problems was defined as the sum of ranks of the signs studied; the effectiveness of stage rehabilitation in patients was defined as the coefficient of the dynamics of the sum of ranks of informative indicator. RESULTS: There was a preponderance of moderate motor impairments; the high incidence of cognitive impairment and paretic hand dysfunctions; a change in the temporal parameters of the nerve impulse through the corticospinal tract; obvious balance dysfunctions; and the relationship between equilibrium and the visual analyzer. The integral indicator of the level of health correlated with clinical and functional findings. After the rehabilitation, severe arm/hand paresis was not detected; paretic arm/hand function improved; the number of patients with moderate paresis declined; impaired vital and social activities reduced significantly; the proportion of patients with low dependence on others was as much as 86%; balance and psychological functions improved; the mean blood pressure reached the target values. An integrated effectiveness evaluation showed that 33, 58, and 9% of patients were discharged with a significant improvement, improvement, and a slight improvement, respectively. CONCLUSION: The integrated approach to evaluating health problems and the effectiveness of rehabilitation makes it possible to comprehensively estimate (taking into account neurological, psychological, functional disorders, risk factors for recurrent stroke) the harm to a patient's health and activity, which is associated with prior stroke and its reversal due to rehabilitation.

[The specific features of the clinical, functional and psychological status of the patients during the early and late restorative periods of ischemic stroke]. / Osobennosti kliniko-funktsional'nogo i psikhologicheskogo statusov patsientov v rannem i pozdnem vosstanovitel'nykh periodakh ishemicheskogo insul'ta.

BACKGROUND: When choosing the algorithm of rehabilitative measures, the localization of the stroke, brain reserve, and neuroplasticity as well as clinical characteristics (motor, postural, speech, cognitive impairments), etc. are taken into consideration. Monitoring the health status of the patients is an integral component of and an important condition for the successful post-stroke rehabilitation. AIM: The objective of the present study was to evaluate the clinical, functional and psychological status of the patients with stroke during the early and late restorative periods. MATERIAL AND METHODS: The neurological disorders were characterized based on the National Institutes of Health Stroke Scale (NIHSS), the results of hand-grip dynamometry, the Frenchay arm test, and the modified Ashworth scale of muscle spasticity in the combination with the data on the activity of everyday life and the psychological status of the patients. Sstabilograpy, encephalography, and diagnostic transcranial magnetic stimulation (TMS) were carried out. The level of health of the patients was evaluated as the integral measure representing the sum of scores of ranked characters. RESULTS: A total of 106 patients who had undergone ischemic stroke were available for the examination. During the early post-stroke period the gross disturbances of attention and vertical stabilization were documented. In addition, the dependence of equilibrium on the function of visual analyzer was revealed together with the large number of correlations between the clinical-psychological indicators and the functional parameters associated with neurological deficiency and disability. In the late rehabilitation period, the improvement of attention, the enhanced capability for maintaining equilibrium, and the positive influence of visual memory on the degree of dependence on the assistance of other persons were apparent in the majority of the patients even though some of them exhibited the signs of severe depression. CONCLUSION: Taking account of the aforementioned clinical, functional and psychological characteristics of the patients surviving ischemic provides a basis for the differential approach to the correction of the complex of rehabilitative measures.

[The evaluation of the effectiveness of cardiac rehabilitation of the patients after percutaneous coronary interventions]. / Otsenka éffektivnosti kardioreabilitatsii patsientov posle chreskozhnykh koronarnykh vmeshatel'stv.

BACKGROUND: Notwithstanding the current abundance of the methodological approaches to the evaluation of the outcomes of medical rehabilitation, the criteria for the effectiveness of the combined influence of the curative physical factors are still inadequate and remain at variance with the principles of evidence-based medicine. AIM: The objective of the present study was to develop a method for the evaluation of the effectiveness of the rehabilitation activities in the patients presenting with the acute coronary syndrome following endovascular cardiac interventions. MATERIAL AND METHODS: This work is based on the results of a prospective single-center cohort-based clinical study involving the subjects who had undergone myocardial infarction following endovascular cardiac surgical interventions. The duration of the patient's participation in the study was 21 days. RESULTS: We have developed the integrative approach to the creation of the unified multi-criteria system for the evaluation of the effectiveness of the treatment of the patients presenting with cardiovascular diseases after percutaneous coronary interventions (PCI). In addition, the step-by-step description of this technology is presented. The algorithm for the calculation of the integrated health index and the evaluation of the overall effect of the rehabilitation activities was proposed based on the assessment of the clinical, laboratory, and functional indicators of the health status together with the psychological characteristics of individual patients. It is proposed to consider an integrated health index as a parameter for estimating the rehabilitation potential of the patients suffering from cardiovascular diseases after percutaneous surgical interventions. CONCLUSION: The proposed system for the evaluating of the effectiveness of comprehensive medical rehabilitation differs from analogous intellectual products in that it excludes the subjective interpretation of the severity of clinical symptoms associated with the concrete pathological process and makes impossible the arbitrary determination of the weight of the peculiar features of the patient's condition. Moreover, it allows to reduce the parameters of different types chosen as the criteria for the evaluation of the effectiveness of rehabilitation to the standardized values, to obtain an unambiguous numerical expression of the results of the rehabilitative treatment, and to compare the outcomes of the rehabilitation activities based at different treatment and prevention settings.

[Psychological diagnosis of cognitive dysontogenesis]. / Psikhologicheskaia diagnostika kognitivnogo dizontogeneza.

The article discusses a systematic clinical and psychological approach to different types of impaired cognitive development in children and adolescents with mental disorders in the context of the concept of cognitive dysontogenesis. The authors describe the types of cognitive dysontogenesis in schizophrenic and autistic spectrum disorders and present two models of its estimation: with complex psychometric and pathopsychological diagnosis and with a support on pathopsychological diagnosis of cognitive development only. Special attention is paid to domestic techniques developed in MHRC, which classify the types of cognitive dysontogenesis in children and adolescents with different disorders of mental development without reliance on psychometric indicators. The developed model of cognitive development profiles allows to make a conclusion about a typical picture of cognitive disorders in different versions of mental pathology.

[The comprehensive step-by-step rehabilitation of the patients after acute disturbances of the cerebral circulation]. / Kompleksnaia étapnaia reabilitatsiia bol'nykh posle ostrogo narusheniia mozgovogo krovoobrashcheniia.

AIM: The objective of the present study was to evaluate the therapeutic effectiveness of the comprehensive one- and two-stage rehabilitation including the application of mirror therapy and orthetics on an individual basis. MATERIAL AND METHODS: The study included 125 patients (66 men and 59 women) at the medium age of 57 (52; 63) years who had undergone the acute disorders of cerebral circulation (the diagnosis was verified based on the results of CT or MRI of the brain). The localization of stroke in the basin of the left middle cerebral artery was documented in 41,1% of the patients and in the basin of the right middle cerebral artery in 58,9% of them. The severity of neurologic deficit was estimated with use of the Stolyarova scale, Ashfort spastic scale, the Timed Walking Test with pegs and nine holes, the Bartel index of the activities of the daily life. Also estimated were the severity of anxiety and depressive disorders (based on the Spilberger and Beck scales). The state of the cognitive functions was evaluated by means of the mini-mental state examination (MMSE) and the Clock Drawing Test). The Medical Outcomes Study Short Form-36 (scores of MOS SF-36) was employed to estimate the quality of life of the patients. The rehabilitation of the patients was conducted either in 1 or 2 stages, i.e. during the early and (or) late post-treatment periods. In the early period, the medicamental treatment, therapeutic physical exercises, paraffinic and ozoceritic applications, hand massage, electrostimulation of the antagonists of the spastic muscles as well as mirror therapy were used. The rehabilitative process during the late post-treatment period was completed using orthetics of the affected (paretic) hand on an individual basis. RESULTS: The two-stage medical rehabilitation exercised during the early post-treatment period after the stroke with the application of mirror therapy promoted the decrease of the degree of paresis in the affected hands from 2.50 (1.68; 3.19) to 1,12 (0.81; 1.75) scores (p<0,001) and the increase of the motor activity of the affected extremities (the volume of movements, walking skills, the ability to fulfil biomechanical tests). The program of the comprehensive rehabilitation based on the use of orthetics of the paretic hand on an individual basis made it possible to achieve the maximum lowering of muscle hypertonia in the hand affected by paresis (to less than 0.50 scores, i.e. by 0.625 scores) [0.06; 0.75] (p<0.05). The maximum efficiency (83%) was achieved by means of two-stage rehabilitation. CONCLUSION: The comprehensive two-stage medical rehabilitation of the patients who had undergone the acute disorder of cerebral circulation with use of mirror therapy in the combination with orthetics on an individual basis produces the high therapeutic effect, with the effectiveness of the treatment amounting to 83% and the considerable positive dynamics of motor functions documented in 59% of the patients.

[Efficiency of therapeutically applied physical factors for vibration disease caused by exposure to local vibration (review of literature).]

Important role in treatment and prophylaxis for vibration disease due to local vibration is played by physical factors. If high frequency components prevalent in occupational vibration, treatment with electric therapy, laser, magnetic fields, lymphatic drainage, hydrotherapy provides influence on leading chains of systemic microangiopathies pathogenesis - dysbalance of regulation influences by vegetative nervous system, vasoconstriction and intravascular changes, vascular permeability and microcirculation disorders. If low frequency coomponents prevalent in occupational vibration, treatment of polyneuropathies and locomotory disorders incorporates trophic processes activation: transcranial electroanalgesia, surface application of mineral waters, manual and subwater massage, ozone therapy, local spark discharges, peloids. Complex use of physical methods also increases human adaptational resources.

[EPIDEMIOLOGIC FEATURES OFNOROVIRUS INFECTION OUTBREAK IN THE REPUBLIC OF NORTH OSSETIA-ALANIA].

AIM: Analysis of epidemiologic features of a norovirus outbreak in Alagir city of the Republic of North Ossetia-Alania and effectiveness of measures of its liquidation. MATERIALS AND METHODS: Data from maps-schemes of water supply system of Alagir city and statistical documentation of Centre of Hygiene and Epidemiology in the Republic of North Ossetia-Alania were used in the study. Indication of norovirus in clinical material and water samples was carried out bypolymerase chain reaction method. RESULTS: Etiological agent of outbreak disease was established--genotype II norovirus. Realization of fecal-oral mechanisms of water transmission pathway of the causative agent of norovirus infection was detected. Conditions facilitating emergence and development of the indicated outbreak were determined--non-satisfactory sanitary-technical condition of water. supply system of the city. CONCLUSION: The studied water outbreak of norovirus infection was caused by GII.17 genotype virus, that currently gradually displaces GII.IV genotype, and was characterized by an intensive start, involvement of all population age groups into the epidemic process (with primary infection of adults), low family focality, predominance of average severity disease forms in the clinical presentation. The counter-epidemic measures carried out ensured rapid localization and liquidation of the norovirus infection outbreak.

[The prospects for the further development of the Belokurikha spa and health resort territory in the Altai Krai (region)].

We undertook a balneological survey of the Belokurikha spa and health resort territory with the purpose of distinguishing and identifying the potential health-improvement areas most promising for the extension and optimization of the therapeutic, tourist and recreational activities. The assessment was focused on the characteristic of the landscape and climatic conditions of the territory, the possibilities for the development of the existing resources of mineral waters and therapeutic muds as well as for the discovery of the potential new ones. The recommendations are proposed to promote the development of different forms of tourism with special reference to its medical and health-improvement aspects. It is suggested that the territory of the «Belokurikha¼ resort¼, «Belokurikha-2¼ and «Belokurikha-3¼ health-improvement areas should be integrated into a single spa-and-health resort district of federal importance.

[The significance of the rehabilitative potential for the combined medical rehabilitation of the patients presenting with acute cerebral circulation problems]. / Rol' reabilitatsionnogo potentsiala v kompleksnoi meditsinskoi reabilitatsii patsientov s ostrymi narusheniyami mozgovogo krovoobrashcheniya.

This article outlines the current WHO concepts of the process of rehabilitation with special reference to the consideration and the analysis of the concept of rehabilitation potential, its structure, levels, and functions of each level. The main stages and the aim of the comprehensive medical and psychological rehabilitation of the patients presenting with acute cerebrovascular accidents (ACVA) are discussed. The importance of the recoverable and reusable resources at the biological and psychological levels that may play the role of compensatory functions in the patients suffering from acute cerebral circulation disorders is emphasized. The three main stages of the rehabilitation process for the ACVA patients («diagnostic¼, «therapeutic¼, and «verifying¼) are described. The necessity of the development of the systemic strategy for medical and psychological rehabilitation of the post-stroke patients is substantiated taking into account the criteria for allocating them to the groups of either early or late rehabilitation and the group of patients suffering from the consequences of acute cerebral circulation disorders. It may allow to achieve the optimal level of the patients' well-being, in accordance with the rehabilitation potential currently attainable for the patients undergoing acute cerebrovascular accidents.

[SEASONAL FEATURES OF SEROTONIN IN BLOOD SERUM OF RATS AFTER PHYSICAL OVERWORK UNDER DESYNCHRONOSIS].

The content of serotonin in the blood serum of rats with light desynchronizes and physical fatigue in different seasons was investigated ву enzyme immunoassay. It was found that long-term light deprivation and exercise to complete depletion lowered levels of serotonin in the blood serum of rats in the winter and increased that of the spring season. At the same time, a dark deprivation and physical activity had no effect on this indicator.

IMMUNOPHENOTYPICAL CHARACTERISTICS OF CELLULAR COMPOSITION IN BREAST MILK.

The morphology and immunophenotype of female colostrum adherent cells with the help of CD3, CD31, CD34, CD45, CD68, vimentin, and osteocalcin antibodies panel was studied in short-term (6­7 days) culture in vitro. Approximately equal (1 : 1) ratio of fibroblast-like and rounded cells was observed in 20 % of cultural flasks. The cells with regular shape mixed with single fibroblasts were noted in 80 % of cultural flasks. The diameter of spreaded cells varied within 10­100 mm. All cells adhered to plastics did not express CD3 and interacted slightly (sl) with antibodies to CD31, CD34, and CD45. At the same time, adherent cells with intensive CD68, vimentin and osteocalcin staining have been revealed. Literature data allows to interpret CD68+CD3­CD31slCD34slCD45sl immunophenotype of significant part of mother colostrum adherent cells as belonging to monocyte-macrophage lineage. Marked expression of stromal antigens (vimentin, osteocalcin) in 40­45 % adherent cells in cultural medium without osteogenic supplements (beta-glycerophosphate, ascorbic acid, dexamethasone) proposes an existence of osteoblasts fraction differentiated in colostrum from mesenchymal stem cells under an action of breast milk humoral factors.

[PROCUREMENT OF SANITARY AND EPIDEMIOLOGICAL WELFARE IN THE REGION OF-CITY-RESORT SOCHI FOR DANGEROUS AND NATURAL-FOCI INFECTIOUS DIS- EASES IN 2015].

AIM: Analysis ofresults of epidemiologic monitoring especially dangerous, natural-foci and other infectious diseases, asill as epizootologic activity of natural foci of infection on,the terri- tory, of city-resort Sochi. MATERIALS AND METHODS: Laboratory studies of 820. samples by PCR; im- mune- and bacteriologic methods were carried out, among those 344 - clinical material, 12 - water from open bodies and 321 - field material. Molecular-genetic identification of-143 strains of Vibrio-cholerae, isolated from open water bodies of city-resort Sochi, was-carried out,. RESULTS: Circulation of causative agents of Q fever, tularemia and hemorrhagic fever with renal syndrome of Dobrava-Adler genotypes was established, -as well as rickettsia of tick spotted fever group Predomination of rotaviruses (70.9%) was detected during study of samples of clinical material in etiologic structure of sporadically emerging acute intestine infections. Relatively high temperature values of river water during summer months (from 18, to 30 C), exit of sulfide mineral waters into the riverbed, that create-alkaline medium, seasonal reduction of river debit and speed of water current facilitated sustenance of contamination of water of Agura river by V.cholerae. CONCLUSION: Activity of natural foci of the infectious disease and contamination of Agura iver by V.cholerae Ο1, (atoxigenic) gives evidence on the necessity of constant control of epidemiologic situation by dangerous and natural-foci infectious diseases on the territory of city-resort Sochi, as well as study regional features, of their causative agents, including using genetic methods.

[A "difficult" pneumonia: problems of differential diagnosis].

There is a significant number of diseases that occur in the guise of community-acquired pneumonia (CAP), so the progressive course, slowly allowed or unresolved CAP search for an alternative disease becomes crucial. In more than 20% of patients with the syndrome of "protracted" pneumonia alternative diagnosis are established. List of the main pathological processes occurring under the guise of pneumonia include: infiltrative pulmonary tuberculosis, acute interstitial pneumonia, acute eosinophilic pneumonia, thromboembolism, pulmonary artery branches, systemic vasculitis, and a number. of other lung diseases. This publication attempts to organize a brief series of problems that practicing physicians often face in the management of patients with "difficult" pneumonia.

[Modern methods of inhalation therapy of respiratory diseases].

In pulmonary practice the effectiveness of the therapy depends on a method of drug delivery. In case of different forms of medications, which can be used for the treatment of patients with obstructive pulmonary diseases physicians usually choose inhalants. In this publication authors examines the main aspects of the use of nebulizers in the treatment of obstructive pulmonary diseases: types of nebulizers, their capabilities and limitations, indications for inhalation therapy and drug policy.

[Clinical guidelines for management of patients with acute chronic obstructive pulmonary disease].

The treatment of acute chronic obstructive pulmonary disease is aimed at minimizing the manifestations of this aggravation and prevention of its progression. This article covers the information about the etiology of acute illness and its diagnosis criteria, recommendations about methods of assessing of exacerbations, place of treatment of this pathology and definition of treatment policy. The data about preferrable means of pharmacotherapy--bronchial spasmolytics, corticosteroids and antibacterial drugs, is given. Recommendations concerning oxygen therapy, respiratory support, mucoactive therapy and prevention of thromboembolic complications are given. An algorithm for the management of patients on an outpatient basis in a hospital is presented.

[Diagnostics and antimicrobial therapy of severe community-acquired pneumonia].

In the current paper authors presented the latest information concerning etiology of severe community-acquired pneumonia. Most cases are caused by a relatively small number ofpathogenic bacterial and viral natures. The frequency of detection of various pathogens of severe community-acquired pneumonia may vary greatly depending on the region, season and clinical profile of patients, availability of relevant risk factors. Authors presented clinical characteristics of severe community-acquired pneumonia and comparative evaluation of a number of scales to assess the risk of adverse outcome of the disease. Diagnosis of severe community-acquired pneumonia includes the following: collecting of epidemiological history, identification of pneumonia, detection of sepsis and identification of multiple organ dysfunction syndrome, detection of acute respiratory failure, assessment of comorbidity. Authors gave recommendations concerning evaluation of the clinical manifestations of the disease, the use of instrumental and laboratory methods for diagnosis of severe community-acquired pneumonia. To select the mode of antimicrobial therapy is most important local monitoring antimicrobial resistance of pathogens. The main criteria for the effectiveness of treatment are to reduce body temperature, severe intoxication, respiratory and organ failure.

[ORGANIZATION OF THE QUALITY CONTROL OF PLACEMENT AND ACCOMMODATION OF PARTICIPANTS ATTENDANTS AND GUESTS OF THE XXII OLYMPIC WINTER GAMES AND XI PARALYMPIC WINTER GAMES OF 2014 IN THE RESORT CITY OF SOCHI].

There is presented the analysis of activities of the Federal Service for Supervision of Consumer Rights protection and Human Welfare to ensure adequate conditions of accommodation of the participants, attendants and guests of the XXII Olympic Winter Games and XI Paralympic Winter Games of 2014 in the Resort city of Sochi according to regulated requirements. There were detected ways of the strengthening the supervision for the quality of the accommodation during mass sports activities for the assurance of the rights for consumers.