The paper presents a critical analysis of the data on incidence and etiology of pneumonia among patients with human immunodeficiency virus (HIV). The features and prospects of differential diagnosis for various types of pneumonia are considered. The paper emphasizes the urgency of highly sensitive methods for diagnostics of pneumonia and its features in HIV-positive patients.

Patient safety is one of the priorities in medical care. The leading place in it is occupied by “correct patient identification”. According to research by experts from the World Health Organization (WHO), “misidentification of a patient is the cause of many errors.” The purpose of this work is to assess the implementation of a patient identification system using bracelets in a multidisciplinary hospital. The main idea of the project is based on the use of personal identifiers, made in the form of a disposable white bracelet worn on the patient’s arm, as well as the use of color-coded bracelets (red, yellow, red-yellow), which allows identifying patients at risk of developing life-threatening conditions: high risk falling of the patient and the presence of an allergological history. The introduction of identification bracelets with patient data and a barcode on them increased the percentage of identification performance increased from 67% to 89%. After the introduction of the system of prevention of falls and color identification by bracelets, the number of falls of patients decreased by more than 4 times. Successful integration of the automatic identification system into the workflow of a multidisciplinary hospital significantly reduces the influence of the human factor on the number of medical errors and related preventable consequences for patient health.

Pregnant women are at the high risk for the development of severe both pandemic and seasonal influenza. There were analyzed medical histories of 277 influenza pregnant women observed in 2009-2016. Patients were divided into two groups: I (113 cases, 40.8%) - influenza A women (H1N1) pdm09, II (164 patients, 59.2%) - seasonal influenza pregnant women: A (H3N2) (109 females, 66.5%) or B (55 cases, 33.5%). Most women developed influenza in the second and third trimester of the gestation (114 cases, 41.2%, and 94 cases, 33.9%, respectively). The duration of inpatient treatment of pregnant women in the first group was significantly longer than in cases from the second group (p

Imbalance of the proteolysis/antiproteolysis system is known to be among key components of immunofibrogenesis of liver in cases of chronic hepatitis C. To evaluate these aspects, we studied several factors of liver tissue remodeling in blood serum and local samples from HCV patients associated with liver fibrosis. We determined the levels of matrix metalloproteinase-9 (MMP-9), tissue inhibitor of matrix metalloproteinase-1 (TIMP-1), MMP-9/TIMP-1 and MMP-9/TIMP-2 complexes. Clinical, laboratory and instrumental examinations have been made for 81 patients with chronic hepatitis C who did not receive antiviral therapy, and 22 healthy volunteers. Extracellular matrix protein (ECM) profile was studied in 103 serum blood samples and 32 liver supernates using ELISA technique. Statistically significant increase of MMP-9 contents (p < 0.05) and its complexes with TIMP-1 (p < 0.05) and TIMP-2 (p < 0.01), as well as low levels of type 1 inhibitor (p < 0.05) were revealed in blood serum of HCV-infected patients, as compared with control group. Protein assays in liver supernates of hepatitis C patients reflecting extracellular matrix state revealed an eight-fold increase in MMP-9/ TIMP-1 complex, as compared with control group (p < 0.05). The values of other proteolytic/antiproteolytic factors proved to be low (p < 0.05). An imbalance in protease contents in blood serum and liver biopsies was revealed, showing differently directed changes. I.e., serum values of MMP-9, TIMP-1 and MMP-9/TIMP-2 during transition of liver fibrosis to cirrhosis (F0 to F4) became decreased (p < 0.05), associated with increased liver concentrations of these proteolytic enzymes (p < 0.05). In summary, we conclude that the data obtained in our study suggest an imbalance of proteolysis/antiproteolysis system leads to a dysregulated liver tissue remodeling in patients with chronic hepatitis C.

Трансформирующий фактор роста-β (ТФР-β) – плейотропный цитокин, принимающий активное участие в поддержании иммунного гомеостаза организме, а также в процессе ремоделирования внеклеточного матрикса. Концентрация ТФР-β1, ТФР-β2 и ТФР-β3 в сыворотке крови у HCV-инфицированных пациентов статистически значимо снижалась (р<0,05) по мере прогрессирования структурных изменений в архитектонике печеночной ткани. Высокие сывороточные значения изоформ фактора роста при ранних стадиях фиброза печени (F0 ст.) относительно их содержания в группе пациентов с выраженными фиброзными изменениями в органе-мишени (F3-4 ст.) могут быть одним из механизмов, который способствует «ускользанию» вируса гепатита С (ВГС) из-под иммунного ответа организма-хозяина. Следовательно, ТФР-β в сыворотке крови, выполняя диаметрально противоположные эффекты (иммуносупрессивный и провоспалительный), на начальных стадиях патологического процесса способствует персистенции и хронизации HCV-инфекции. Дальнейшее прогрессирование хронического гепатита С (ХГС) с формированием фиброза и цирроза печени сопровождается снижением системного уровня всех изоформ фактора роста, что, вероятно, связано с реализацией профиброгенного эффекта ТФР-β непосредственно в органе-мишени. Таким образом, результаты исследований могут свидетельствовать о ключевой роли плейотропного ТФР-β в иммунофиброгенезе печени при HCV-инфекции.

Chronic hepatitis C antiviral therapy should be followed by immune rehabilitation measures directed to T-cell immunity stimulation and elimination of circulating immune complexes. The dynamics of concentrations of molecular fractions of circulating immune complexes and immunoglobulins has been studied. Moreover, phagocytosis indices were evaluated during combined antiviral therapy by standard PEG-interferon and ribavirin and immuno correction drag Ronkoleukin. Application of Ronkoleukin in combination with antiviral therapy determines possibilities to optimize existing treatment protocols of chronic hepatitis C.

The paper studies clinical, biochemical and virological parameters and immunological indicators of liver fibrosis in 120 patients with chronic viral hepatitis of different aetiology (B, C and mixed В+С, В+D, B+C+D). The mixed viral involvement caused more massive changes in the clinical picture of the disease. All the cases were characterized by the decrease in the matrix metalloproteinase-9 content in blood serum. Its deficit correlated with the progression of fibrotic changes in liver. Contrariwise, there was an increase in the protease with inhibitor level. The high indices were detected in case of viral hepatitis B of both monoand mixed infections that could be explained by progressive fibrotic changes and marked cancer-causing potential of this pathogen. The authors indicate the direct dependence between the degree of viral load and degree of liver fibrosis.