Vol 20, No 6 (2014)

The results of analysis of provision of medical organizations with specialists of primary medical care testify increasing of provision with general practitioners up to 35.7%, especially in the Southern Federal okrug. However, provision with district physicians-therapists was invariably low during all analyzed period and factually in all okrugs of country trended to decreasing. The provision with district paediatricians in profile of Federal okrug trended to decreasing. The number of visits to specialists of primary medical care increased. The under-staffing was compensated by combining jobs of vacant positions.

The article presents the mode of treatment of patients with cholangitis including effect of laser irradiation on endothelium of biliary ducts by means of fiber optical light guide introduced into ducts through trans-hepatic drainage without traumatic operative intervention. The analysis is presented concerning treatment of 58 patients with cholangitis (main group) previously operated because of intra-ductalpathology including choledocholelithiasis and stenosis of terminal part of choledoch. The control group consisted of 45 patients with trans-hepatic drainage receiving only antibacterial therapy. The reological characteristics of bile after laser irradiation effect were analyzed. The application of new technique made it possible to enhance the results of treatment of patients with cholangitis and obtain more stable and faster effect of regression of inflammatory process in biliary ducts with normalization of their function and reduce to minimum undesirable complications accompanying traditional methods of treatment of given category of patients.

The article presents data of clinical epidemiological study of 708 schoolchildren concerning infection by chlamydia the mucous membrane of upper part of respiratory tract. The diagnostic of chlamydia infection was implemented using technique of direct immunofluorescence. The specific structure of identified chlamydia depending on age and gender is demonstrated. The prevailing of acute and chronic ENT pathology in children with respiratory chlamydias as compared with non-infected persons is demonstrated.

The circulation of virus of tick-borne encephalitis in composition of stable parasitic system including virus, tick-agents and vertebrata of many species excludes possibility of total elimination of virus under alteration of numbers of particular species of tank hosts. The inactivated vaccines developed about 40-77 years ago with vaccine strains of Far Eastern and European genetic types are applied to prevent tick-borne encephalitis in spite of domination of Siberian type of virus of tick-borne encephalitis in most endemic oblasts of Russia. The new approaches to development of vaccines include application of modern strains of three main genetic types of virus of tick-borne encephalitis using cell cultures instead of fibroblasts of chicken embryos. The DNA- and RNA-immunization, multiple antigen peptides and alteration of adjuvants and addition of cytokines are applied too. The diagnostic of tick-borne encephalitis is based on detection of antibodies in enzymoimmunoassay and detection of viral RNA using reverse transcription with polymerase chain reaction in real-time. The comparison of techniques of detection of tick-borne encephalitis according their sensitivity and specificity objectifies necessity of combined approaches. The specific and effective preparations for treatment of tick-borne encephalitis are unknown nowadays. Therefore, the schemes of treatment in different countries situated in risk zones differ. In Russia, treatment of tick-borne encephalitis is based on application of specific immunoglobulin from serums of donor blood, analogues or inductors of interferons and ribonuclease A from pancreas of bull as well. However, it is known that such high molecular weight proteins as immunoglobulins and ribonucleases with molecular mass from 12.3-13.7 no 45-150 kD are not capable to penetrate eukaryotic cells and extra cellular virions. Hence, their possible effect is limited by surfaces of infected cells and virions. Also, the risk of contamination of preparations from donor blood or organs ofr animals as infection agents is not excluded.

In modern conditions the multimorbidity is an integral trait of chronic obstructive disease of lungs. The cardiovascular diseases are found more frequently in patients with chronic obstructive disease of lungs than in total population. According to modern concepts, systemic inflammation related to unbalance of pro- and anti-inflammatory cytokines is important in pathogenesis of chronic obstructive disease of lungs. This can be a cause of development of extra pulmonary manifestation of chronic obstructive disease of lungs and comorbide diseases and especially cardiovascular diseases. The article considers studies covering major bio-markers being additional instrument to evaluate risk and prognosis in patients with concomitant diseases under chronic obstructive disease of lungs.

The article considers application of markers of acute damage of kidneys (cystatin C, molecule of kidney damage-1, interleukin 18 and protein binding hepatic fatty acids of L-type) and most perspective of them - neutrophil gelatinase associated lipocalin (NGAL) in cardiology and in particular under acute coronary syndrome. Among markers of acute damage of kidneys specific attention was paid NGAL (in blood and urine). Its participation in pathogenesis of cardiovascular diseases is marked. The results of application of NGAL under different forms of ischemic heart disease, acute cardiac insufficiency, in cardiac-surgical patients are presented. The advantages of NGAL in comparison with markers of acute damage of kidneys mentioned above are demonstrated. At the same time, it is marked that there is not enough data testifying prognostic value of NGAL under acute coronary syndrome. There is not enough information about its comparison and interaction with natriuretic peptides.