Vol 27, No 5 (2022)

BACKGROUND: The detection of cardiovascular pathology in patients at various stages of HIV infection is highly relevant. Given the data presented in the scientific medical literature on the negative impact of this infection on the cardiovascular system (CVS), a higher level of mortality in this group of patients from cardiovascular diseases has recently increased several times.

AIM: to identify cardiovascular pathology in patients at different stages of HIV infection (3 and 4), to determine the relationship with antiretroviral therapy (ART) regimens to improve the quality of medical care and disease prognosis.

MATERIALS AND METHODS: We examined 60 patients (outpatient and inpatient) with HIV infection at different stages of the disease from June 2020 to December 2021. Retrospectively, an analysis was performed of electronic medical records of persons registered and observed at the MHC AIDS DZM (supervisor — MD, prof. A.I. Mazus) based on the State Budgetary Healthcare Institution ICB No. 2 DZM. The following were analyzed: age, gender, medical history (terms of the disease, comorbidities), results of an objective examination, routine laboratory blood tests, and ART regimens. Cardiovascular pathology was identified by performing special instrumental diagnostics — ECG, Echo-KG, and Doppler ultrasound of the brachiocephalic arteries —followed by a consultation with a cardiologist in case of abnormalities. Categorical data were described with indications of absolute values and extensive indicators. Quantitative indicators were assessed for compliance with the normal distribution using the Shapiro-Wilk test and the Kolmogorov-Smirnov test. Statistical processing was performed using Microsoft Excel and StatTech v. 1.2.0. Differences were considered statistically significant at p <0.05.

RESULTS: Based on the data presented, it can be noted that the observed group of HIV-infected patients was of middle age (41.3±8.5 years), and men accounted for 78%. Cardiovascular pathology was detected in 38 (63%), and stage 4 HIV infection was 71%. Among the pathologies of the heart, infective endocarditis (IE) with damage to the tricuspid valve (58%) was most often diagnosed, and most of them (77%) had stage 4 HIV infection. An analysis of the intake of ART showed that in patients who did not receive it for the entire period of the disease, such pathology was detected in 68.4% of cases; among patients with late initiation of ART or lack of adherence — in 58% of cases; in those who received ART in a timely and regular manner, cardiovascular pathology was diagnosed five times less often — in 11.8%, which indicates an obstructive effect of ART on the development of cardiovascular pathology in HIV infection. The statistical significance of the development of IE in the group of patients with intravenous use of PAS was revealed, which suggests the influence of drug addiction on the occurrence of heart pathology.

CONCLUSION: The data obtained from this study may have specific practical significance, suggesting criteria for examining patients with HIV infection to identify cardiovascular pathology, which will affect the quality of medical care and the prognosis of the disease.

BACKGROUND: Resistance of microorganisms to antimicrobial drugs (AMP) is one of the global problems of modern medicine, which poses a serious threat to human health. The formation of the resistance of pathogens to AMP forces us to look for new ways to combat them. Probiotic therapy is one of the promising and safe methods of treating many infectious diseases.

AIM: This study assesses the sensitivity of clinical strains of pathogenic and opportunistic bacteria and fungi to microorganisms that are part of probiotic preparations.

MATERIALS AND METHODS: The sensitivity of 93 cultures of pathogenic and opportunistic microorganisms (UPM) isolated from the feces of patients with intestinal dysbiosis to strains of probiotic bacteria isolated from commercial probiotic preparations was studied: Lactobacillus plantarum 8RA-3, Escherichia coli M-17, Bacillus subtilis strain VKPM B-10641, Enterococcus faecium SF-68, Saccharomyces boulardii CNCM I-745 by the delayed antagonism method.

RESULTS: Pathogenic microorganisms showed low and moderate sensitivity to the probiotic strain of L. plantarum. Sensitivity to the probiotic strain of B. subtilis was detected in Staphylococcus aureus strains, low or completely absent in Pseudomonas aeruginosa, Klebsiella spp., Serratia marcescens. The most sensitive to the probiotic strain were clinical strains of E. coli.

CONCLUSION: UPM and pathogenic microorganisms isolated from the gastrointestinal tract of patients with dysbiosis have different sensitivity to probiotic strains: from high to several probiotics to its complete absence. The empirical approach to prescribing a probiotic does not guarantee a therapeutic effect, which makes it prudent to individualize the selection of a probiotic based on an assessment of its antimicrobial activity against isolated pathogens.

This work is a comparative analysis of the experience of the legal regulation of public relations in counteracting the development of epidemics (pandemics) in the USSR and the Russian Federation. It is considered in the context of the legal formulation of a model of socially useful behavior of an individual. The model of socially useful behavior of an individual under conditions of the threat of epidemics in the USSR was normatively formed by the 70s–80s and included the traditional law-abiding and active components. The first was based on the population’s knowledge of the normatively fixed rules of action in the event of foci of the spread of specific diseases. The second was associated with the involvement of the public in the direct implementation of anti-epidemic measures.

It is revealed that the current Russian legislation does not create sufficient legal prerequisites for forming of a legal model of socially useful behavior of an individual. The circumstances that led to such a situation are indicated. It was concluded that it is necessary to accumulate its inherent restrictions and prohibitions in the uniform federal Rules of conduct for citizens and activities of organizations under the threat of epidemics of dangerous diseases with the provision of the states of the Russian Federation with the right to authorize their application to create legal prerequisites for the formation of a traditional law-abiding model of socially useful behavior of an individual.

Forming a legal model of socially active behavior of an individual requires the definition of legal forms and the permissible degree of public participation in preventive work by analogy with the extensive Soviet experience. In contrast, the incentives for useful behavior should be a ramified system of legal guarantees in the fields of labor, social security, education, and related areas, and their interrelationships.