Journal «MEDICINA» 4/2021

The consensus opinion of Russian experts «Antithrombotic therapy in the elderly and senile age» (2021) contains selective and insufficiently correct data, obtained in randomized controlled trials RE-LY, ROCKET AF, ARISTOTLE and ENGAGE AF-TIMI 48. As a result, it makes the impression that dabigatran 150 mg twice daily showed the least safety compared to warfarin in patients 75 years or older. This paper presents the corrected and supplemented data of the ROCKET AF trial, indicating that in patients 75 years or older rivaroxaban compared with warfarin showed no better safety profile than dabigatran 150 mg twice daily in the RE-LY trial.

Key words: dabigatran, rivaroxaban, apixaban, edoxaban, elderly

An assessment of the economic availability of direct oral anticoagulants for COVID-19 outpatient treatment was carried out. For each anticoagulant, the average cost of the package and treatment course were determined, the coefficients of availability in relation to the average wage and the minimum living wage were calculated. Based on the results of the study, an ABC analysis was carried out. The costs of dabigatran, apixaban and rivaroxaban were found to be in category A (high cost) in relation to the minimum living wage. The most accessible of the investigated anticoagulants is apixaban 5 mg in a package of 60 tablets, the coefficient of availability of this drug in relation to the average wage was 21.7, in relation to the living wage – 66.1. The low availability of anticoagulants for the course treatment of COVID-19 in outpatient settings justifies the need for the formation of drug programs for COVID-19 outpatient with at the expense of the federal budget.

Key words: economic availability, anticoagulants, COVID-19

The article examines the subject composition of persons entitled to compensation for moral harm in the event of violation of citizens' rights in the event of harm to life in the provision of medical care, based on the norms of international law, current Russian legislation, theoretical materials and judicial practice. The composition of persons entitled to compensation for moral damage is analyzed. Examples from judicial practice are presented.

Key words: defect in the provision of medical care, medics, moral harm, forensic medical examination

Introduction: The article presents an analysis of the state of the immune system of HIV-infected patients with tuberculosis, the rate of recurrence of tuberculosis in HIV-infected people against the background of insufficient preventive therapy against HIV-infection and tuberculosis. Aim: To assess the effect of clinical aspects of the course of combined pathology (HIV infection and tuberculosis) on the spread of isolation of bacteria of tuberculosis mycobacteria as one of the main risk factors for infection in foci. Materials and methods: comparative analysis of isolation of bacteria of tuberculosis mycobacteria among patients with combined pathology (tuberculosis and HIV) was carried out (main group): determination of CD4 lymphocyte cell number and isolation of tuberculosis mycobacteria (n = 100). The number of TB recurrences in the main group (100 patients) and comparison group (TB patients) – 100 patients were studied. Data processing was carried out using the calculation of intensive and extensive indicators, the calculation of the standard error of the average (m). Statistical analysis was performed using Microsoft Excel. The results testified: the impact of the clinical course in tuberculosis patients with HIV infection characterized by an immunodeficiency condition, the presence of stages of 4B and 4V HIV infection (65,0 (95% RI:55;74)) and the recurrent course of tuberculosis in 25% (95% RI:17,5;34) is 1.4 times higher than in tuberculosis and is one of the main risk factors for infection in foci.

Key words: tuberculosis, HIV-infection, combined pathology, isolation of bacteria

The article presents the structure of causative agents of urinary tract infection (UTI) in sick children in the nephrological department of the Children's City Clinical Hospital No. 2 in Almaty, interpreted according to the results of a retrospective analysis of 328 case histories. Based on the study, it was revealed that the most common pathogen is E. coli 35.4% of the total number of sick children. It was determined that girls in the age group from 0 to 3 years get sick 1.8 times more often.

Key words: urinary tract infection, E. coli, children, nephrology, diagnosis, clinical manifestation, bacteriological culture

Introduction. Chickenpox is one of the most common and highly contagious infections. Since the domestic vaccine has not been developed at the moment, and the purchase of an imported vaccine for routine vaccination is an expensive investment of the state, there is a need to assess the epidemiological and socio-economic effectiveness of vaccination. Purpose: to evaluate the epidemiological and socio-economic effectiveness of a single vaccination program against chickenpox in children aged 6 years on the example of the Altai Territory. Materials and methods. The materials were the reporting forms No. 2 of the Federal State Statistical Observation «Information on infectious and parasitic diseases» in the city of Barnaul for 2001-2019. The economic assessment was carried out on the basis of MU 3.3.1878-04 of 04.03.2004 «Economic efficiency of vaccination». The method of simulation modeling was used to assess the epidemiological effectiveness. Results. The cost of treating chickenpox is almost twice the cost of a vaccination program. The self-sufficiency of vaccination of a cohort of children 6 years of age against chickenpox, carried out in 2021, will be achieved during 2031, and in the future, the damage prevented will constantly increase. The economic benefit will amount to about 7.52 million rubles, and the prevented damage will exceed the costs by 1.2 times. The epidemiological effectiveness of vaccination is observed after five years of the program implementation, the incidence decreases 2-2.5 times. Conclusions. Taking into account the data of literary sources, it is advisable to vaccinate children according to the program of double cohort vaccination with the introduction of the first dose of the vaccine at 12 months and the second dose at 6 years. However, in regions such as the Altai Territory, where previously there was no vaccination of chickenpox, at the initial stage of implementation it is necessary to vaccinate children over 6 years of age in order to prevent the «maturation» of the infection.

Key words: chicken pox, economic damage, vaccination

The article presents the results of a study on the assessment of the strategy implemented in the Altai Territory for ensuring the epidemiological control of the incidence of tick-borne encephalitis and Siberian tick-borne typhus in the period from 2000 to 2019. Within the framework of the study, ternary graphs visualizing the strategy of preventive and anti-epidemic measures used in the region in relation to these infections were constructed and analyzed, namely the influence of vaccination factors, seroprophylaxis and acaricidal treatments on the incidence of tick-borne encephalitis. The results of the regression analysis of the dependence of these factors on the incidence rates of the studied nosologies are presented. The prospective scope of preventive and anti-epidemic measures has been calculated.

Key words: tick-borne encephalitis, tick-borne viral encephalitis, tick-borne rickettsiosis, Siberian tick-borne typhus, regression analysis, ternary plots, tick-borne infections, natural focal infections

Cannabis continues to be the most widely used drug worldwide. Recently, there has been two trends in the field: a liberalization of cannabis-related legislation in a number of countries, as well as an increase in the content of the psychoactive component in cannabis plant – tetrahydrocannabinol. The review covers a topic that has been little studied in Russian addiction science – cannabis use and associated psychotic disorders. Research materials: publications in the Pubmed and RSCI databases. Topics addressed include: cannabis use and psychotic disorders; alternative views on the causal relationship between cannabis use and psychotic disorders; gender specifics in the development of psychotic disorders; genetic predisposition to the development of psychotic disorders in cannabis users; problems with cannabis use in adolescence; possible reasons for using cannabis; suicidal behavior of cannabis users; relationship between cannabis and tobacco use; clinical aspects of treating cannabis users with psychotic disorders; promising areas of future studies. In the absence of domestic research on these topics, such a brief review may help addiction doctors to get a general idea of the modern state of the problem.

Key words: cannabis, psychosis, schizophrenia, tetrahydrocannabinol, cannabidiol, psychotic disorders