卷 29, 编号 2 (2024)

BACKGROUND: The COVID-19 pandemic became a challenge and caused significant social and economic damage to most countries. For the most objective assessment of the epidemiological and clinical features of COVID-19 during different periods of the epidemic, studies based on a large volume of data on patients identified throughout the Russian Federation are necessary.

AIM: To analyze the epidemic process and clinical and epidemiological features of adult patients with COVID-19 identified during the first and second periods of the rise and decline in the incidence of COVID-19 in Russia.

MATERIALS AND METHODS: This study included patients aged ≥18 years with a confirmed diagnosis of COVID-19 and identified in the periods from March 2, 2020, to June 30, 2020 (n=286,205) and from November 1, 2020, to January 31, 2021 (n=1 655 022), in Russia.

RESULTS: At the early stage of the COVID-19 epidemic in Russia, two periods of the rise and fall in incidence were noted: March–August 2020 and September 2020–May 2021, using the Wald–Wolfowitz test. The median age of the patients with COVID-19 in the first and second periods were 50.0 [37–62] and 52.0 [39–64] years, respectively, and women accounted for 55.5 and 60.1% of the patients, respectively. The distributions of patients according to disease severity in the first and second periods were as follows: mild, 63.0 and 74.4%; moderate, 29.0 and 20.1%; severe, 4.9 and 3.5%; extremely severe, 3.1 and 2.1%, respectively. In the first and second periods, cases were dominated by patients aged 50–59 years (20.5%) and 60–69 years (20.5%), respectively. In both periods, the median duration from the onset of symptoms to diagnosis was 4 days, the median disease durations were 16.0 [12–21] and 13 [10–17], and the median duration of hospitalization were 15.0 [12–20] and 13.0 [10–18]. The hospitalization rates were 48.4 and 25.6% in the first and second periods; transfer rates to the ICU, 7.8 and 10.3%; and invasive mechanical ventilation rates, 5.6 and 7.7%, respectively. In both periods, the median age at death was 73 [66–82] years, with a higher proportion of men aged 30–39, 40–49, 50–59, and 60–69 years. The presence of one or more chronic diseases, as well as male sex, increased the likelihood of death (odds ratio = 10.2 and 1.3 in the first period; odds ratio = 16.0 and 1.6 in the second period).

CONCLUSIONS: In the early period of the COVID-19 epidemic in Russia, related to the spread of the wild strain of SARS-CoV-2 and genetically closely related variants, the manifestations of the epidemic process and clinical and epidemiological characteristics of patients varied. In the second period with higher incidence and mortality rates than the first period, the frequency of severe and extremely severe COVID-19 and the frequency and duration of hospitalizations decreased; however, the frequency of transfers into the intensive care unit and artificial lung ventilation slightly increased.

BACKGROUND: Preventive care and successful treatment of infectious diseases (including hospital-acquired infections) are among the most important tasks of modern healthcare. Not many effective antiseptics and disinfectants available can solve this problem. Quaternary ammonium salts are currently one of the promising classes of disinfectants; however, their use is limited by the ability of microorganisms to develop resistance to the compounds. Modification of quaternary ammonium salts with substituents of various profiles is a possible way to solve this problem.

AIM: To conduct a comparative analysis of the bactericidal activity of two original quaternary ammonium compounds based on pyridoxine in comparison with benzalkonium chloride.

MATERIALS AND METHODS: The bactericidal profiles of 0.1 and 0.2% aqueous solutions of original quaternary ammonium salts based on pyridoxine were studied against two widespread pathogens: Staphylococcus aureus and Escherichia coli. Antibacterial activity data were obtained using a standard in vitro test (bactericidal activity test on a metal surface; exposure time of 1, 5, and 15 min). In addition to standard conditions, antibacterial efficacy was studied under protein loading conditions, in which BSA solution was added to the surface.

RESULTS: For the studied compounds, the reduction factor (RF, reduction lgCFU of microorganisms) was on average ≥3. Protein loading led to a decrease in efficiency by 1–3 times. An interesting effect of exposure time-dependent specificity reversal to the S. aureus and E. coli was observed.

CONCLUSIONS: The results showed the high activity of the studied compounds, which corresponds to the effectiveness criterion of RF ≥3 for commercial compounds used in this field.

Fibrosing cholestatic hepatitis is a special variant of infectious hepatitis, with a rapid progressive deterioration of liver function, and usually results in immunosuppression. It has also been reported in patients with immunocompetent status having viral hepatitis B and C. Fibrosing cholestatic hepatitis is diagnosed based on the histological examination of the liver tissue, which reveals severe damage to hepatocytes with pronounced ballooning over a weak inflammatory reaction, pericellular and perisinusoidal fibrosis, and intracellular and tubular cholestases. Analysis of the literature confirms the authors’ assumption that pathological changes in the liver, described as fibrosing cholestatic hepatitis, can develop in different conditions under the influence of various infectious agents. Despite the availability of effective antiviral therapy for hepatitis B and C, the outcomes of fibrosing cholestatic hepatitis are often unfavorable, particularly in cases not associated with solid-organ transplantation. Currently, because of the emergence of numerous drugs that selectively act on the immune system and the development of new areas of medicine such as hematology, rheumatology, oncology, transplantology, and infectious diseases, doctors in these specialties increasingly encounter severe liver damage in patients receiving specific therapy. The authors believe that doctors who do not work at liver transplantation centers underestimate the possibility of fibrosing cholestatic hepatitis development in patients with viral hepatitis B and C, in the clinic of infectious and internal diseases.

This study describes a clinical case of severe leptospirosis. Patient K., was admitted to the neurosurgical department on November 26, 2023, with a diagnosis of “Closed craniocerebral injury dated 22.11.2023. Severe brain injury. Linear fracture of the occipital bone. Eyelid hematoma. An abrasion of the upper eyelid on the right.” On November 29, 2023, an objective examination drew attention to an increase in body temperature to 39.5°C, subictericity of the sclera and skin, and conjunctival injections. Hemorrhagic rash appeared on the skin of the trunk and limbs. The hemodynamics was unstable, with episodes of arterial hypotension. Laboratory examination revealed mild anemia, signs of hepatic–renal insufficiency, hyperbilirubinemia, and increased concentrations of creatine phosphokinase, C-reactive protein, and procalcitonin. Fluctuations in hepatic–renal insufficiency and levels of creatine phosphokinase and procalcitonin increased. In addition, the differential diagnostic search aimed at identifying the following infectious diseases: hemorrhagic fever with renal syndrome, leptospirosis, malaria, and viral hepatitis. IgM to Leptospira interrogans were detected (December 11, 2023). The patient received antibacterial therapy, extracorporeal detoxification, artificial ventilation, infusion therapy, and correction of the hemostasis system. With the complex treatment, the patient’s condition stabilized, and the patient was discharged from the hospital on the 61^st day with restoration of health.

Over the past 3 years, the number of new cases of brucellosis has increased in the Russian Federation. Brucellosis remains an important problem in regions with developed livestock farming; however, cases of diseases in animals and humans can also be recorded in other regions.

The article describes an outbreak of brucellosis in a peasant farm affecting 148 heads of cattle and 4 farm employees in the Novosheshminsky municipal district of the Republic of Tatarstan. The disease was caused by Brucella abortus. Epizootic and epidemiological maps of the outbreak, sanitary and epidemiological survey activities, and sanitary and hygienic characteristics of the working conditions were analyzed. Data from the case histories of four peasant farm workers with brucellosis are also presented.

The most likely cause of the epizootic was the unauthorized import of cattle, and infections in humans were caused by noncompliance with working conditions and personal-protective measures by farm workers.

Brucellosis cases are more often recorded in endemic areas. However, with poor veterinary and sanitary control in any territory, epizootics are possible, which pose a danger in terms of damage to the national economy and possible infection in humans, primarily the professional risk groups. The disease does not have pathognomonic symptoms and can be suspected only if doctors are aware of them, evaluate the results of preliminary and periodic medical examinations with laboratory examinations of “at-risk” populations, and subject them to a thorough collection of epidemiological history.