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The paper considers the key areas of international activities of the Federal Service for Surveillance on Consumers’ Rights Protection and Human Well-being in strengthening cooperation with specialized agencies of foreign countries in the global provision of sanitary-epidemiological welfare of the population at the current stage. Consistent work to strengthen the international network to counter emergency situations of a sanitary and epidemiological nature through effective interaction in the field of rapid response with partner countries in the near and far abroad, including through the organization of joint scientific and practical centers for the study and prevention of infectious diseases is presented. It is shown that the programs being implemented are aimed at strengthening the national healthcare structures of partner countries to achieve independence in the implementation of monitoring and anti-epidemic measures and building a single epidemiological space, independent of the influence of global and regional geopolitical fluctuations. The relevance of increasing interstate cooperation in the field of analysis and control of biological threats, primarily infectious diseases with the potential for emergencies of a sanitary and epidemiological nature of international concern, in the South American region is considered. The currently expanding strategic biosecurity collaboration with the Bolivarian Republic of Venezuela through the establishment of the first joint research center in the South American region is described. The first results of the joint work of Russian and Venezuelan specialists are presented, confirming the successful integration of Russian experience in monitoring and preventing biological threats into the system of ensuring the sanitary and epidemiological well-being of the Venezuelan population. Promising areas for further joint research are discussed.

The current study summarizes and analyzes new challenges to the sanitary protection of the Russian Federation related to the dynamics of the epidemiological situation in the countries of the world and trends in the structure of international passenger traffic.The aim is to improve approaches to reducing the risks of importation of dangerous infectious diseases based on development of additional criteria for dynamic assessment of epidemiological disadvantage in foreign countries and individualization of risk determination in relation to all in-coming flights.Materials and methods. The present-day epidemiological situation was analyzed using data from reports and periodicals of WHO, Centers for Disease Control and Prevention, Ministries of Health of the countries and scientific publications. Information on the structure of passenger traffic is provided according to the portal of the Unified Interagency Information and Statistical System (pre-pandemic period – 2018, first half of the year 2023). Statistics on transport communication was obtained from the public reports of the Ministry of Transport of the Russian Federation and the Federal Air Transport Agency for 2022 and the first half of the year 2023. Information on the results of the sanitary-quarantine control (SQC) is presented according to the data logged in the automated information system “Perimeter”.Results and discussion. Taking into account the analyzed data in regard to the new threats to the system of sanitary protection of the territory of the Russian Federation, infections in the list of infectious diseases, requiring sanitary protection measures, should be differentiated into two categories based on the criteria of significance for implementation of SQC. A set of criteria, including retrospective analysis of morbidity, the presence of persistent conditions of stable circulation of the pathogen and the possibility of transmission from person to person in case of introduction into the territory of the Russian Federation, has been put forward for the most relevant medium-term assessment of the risk of importation. In addition, the increasing threats and challenges to sanitary protection dictate the need to use advanced information technologies within the framework of sanitary-quarantine control.

The aim of the review was to assess the epidemiological situation in natural plague foci in the Russian Federation, near and far abroad countries in 2023 and to forecast their epizootic activity for 2024. In 2023, cases of plague were registered in five countries worldwide: the Democratic Republic of the Congo (60 cases), the Republic of Madagascar (14), the United States of America (2), the People’s Republic of China (3), and Mongolia (5). A total of 84 cases of plague were recorded, of which 22 (26.2 %) were fatal. In the Russian Federation, in 2023, epidemic risks in epizootically active natural foci were significantly reduced due to the implementation of a set of preventive measures carried out by Rospotrebnadzor institutions, which was the guarantor of ensuring epidemiological well-being as regards plague. Plague epizootics were detected on the territory of two (Gorno-Altai high-mountain and Tuva mountain) out of 11 natural plague foci in the Russian Federation in 2023. Epizootics were reported on the territory of the Kosh-Agach district of the Altai Republic and the Mongun-Taiginsky kozhuun of the Tuva Republic. The total area of epizootics was 731.2 km2 (in 2022 – 248.3 km2). In total, 55 cultures of the antique biovar of the main subspecies Yersinia pestis pestis were isolated in 2023 (19 in 2022). The forecast for continuation of the tense epidemiological situation in the territory of the Altai and Tuva Republics in 2024 is substantiated. The trend of sustained growth in the epizootic potential of the East Caucasus high-mountain and Dagestan plain-piedmont plague foci is outlined. The prospects for introducing an automated electronic system for assessing the epidemic potential of natural plague foci into practice are explained.

The paper describes the epidemiological situation in the countries of the world in terms of the incidence of Hantavirus diseases. The results of an epidemiological analysis of the incidence of hemorrhagic fever with renal syndrome (HFRS) in the Russian Federation in 2023 by federal districts are presented and a forecast for 2024 is made. In 2023, 5 093 cases of HFRS were registered in the Russian Federation (3.47 per 100 thousand population). The incidence was reported in 7 out of 8 federal districts of the country. The age structure was dominated by people in the 30–59 age category (65.7 %); 247 cases of the disease were noted among children under 17 years of age. The proportion of the male population was 70.3 %. 63.2 % of the total number of cases was registered among the urban residents. The mortality rate was at the level of 0.49 % – 25 lethal outcomes. Analysis of the data has revealed a decrease in the incidence of HFRS in Russia by 27.2 % as compared to the previous year. However, the data from epizootiological monitoring and the results of laboratory research of field material indicate a continuing tense situation in the country as a whole. In a number of regions, a high risk of complications of the epidemiological situation is predicted (mainly, in the constituent entities of the Volga and Central Federal Districts). Moderate risks of developing local complications of the epidemiological situation at the level of long-term average morbidity are expected to be realized in the entities of the Northwestern, Ural and Far Eastern Federal Districts. Sporadic cases of the disease in the territory of the Southern Federal District are not excluded. The aggravation of the situation on HFRS in the territory of the North-Caucasian and Siberian Federal Districts is not anticipated in 2024.

Sanitary and quarantine control (SQC) at the state border of the Russian Federation is the first barrier to the importation and subsequent spread of diseases on the territory of the country. Every year the number of registered outbreaks of infectious diseases in the countries of the world increases, which entails an increase in published information, some of which is unreliable and requires verification. At the same time, against the background of the development of international tourism, increase in passenger traffic, the risk of infectious diseases importation into the territory of Russia rises manifold, which creates the need for modernization of information and technical support of the SQC. In connection with the above, the aim of the work was to develop a scientifically substantiated system of informatization and digitalization of SQC, which resulted in the introduction of an automated risk assessment system as regards importation of dangerous infectious diseases (AIS “Perimeter”) at all sanitary-quarantine checkpoints (SQP). Materials and methods. The information system was created using the following software platforms: Laravel, VueJs. The official websites of the Ministries of Health of the respective countries, data from the official regional websites of WHO, regional centers for disease control and prevention (CDC), and data from the ProMED-mail system were used as sources of information on infectious morbidity in the countries of the world. Results and discussion. Implementation of AIS “Perimeter” has brought about the maximum possible efficiency in the targeted informing of SQP officials about the current epidemiological situation in the countries of the world; an effective tool for monitoring the situation at the federal level in real-time mode. It facilitates the work of SQP, staff related to conducting standard operational procedures, due to considerable decrease in the volume of routine activities to keep records. The proposed in the AIS expert risk assessment as regards importation of infectious diseases allows SQP employees, based on reliable information, to make timely decisions on the need to conduct SQC and exclude erroneous actions in the essential set of measures within the framework of SQC implementation, while minimizing subjectivity with respect to decision making.

The aim of the study was to zone the territory of the Saratov Region using indicators that influence the intensity of epidemic manifestations of hemorrhagic fever with renal syndrome (HFRS), and to assess the risk of infection of people for a differentiated approach to the organization of anti-epidemic measures in natural foci.Materials and methods. When calculating the intensity of epidemic manifestations of HFRS in the administrative-territorial units (ATUs) of the Region, the indicators that have the greatest impact on the risk of infection were selected: the intensive rate of morbidity among population, the rate of infection of carriers with the HFRS virus, the number of recreational facilities, and the forest cover rate. The paper presents personalized data of HFRS patients, the results of epizootiological monitoring, information about recreational facilities and the forest fund of the Saratov Region. All the data considered cover the period of 2010–2022 for each of the administrative districts of the Region and the city of Saratov. To calculate the intensity of epidemic manifestations, the dimension method and the decimal logarithm were used.Results and discussion. As a result of calculations, 8 ATU of the Regions have been classed as the territories with the highest intensity of epidemic manifestations and the risk of HFRS infection, with high intensity – 9, with medium – 10 and low – 12. Epidemiological geo-information analysis made it possible to establish that the territories with the highest intensity of epidemic manifestations of HFRS occupy 15.8 % of the area of the region, high – 23.8 %, medium – 28.5 %, low – 31.9 %. Based on the findings of the study, 16 districts of the Region and the city of Saratov were identified as the most dangerous in terms of HFRS infection. Namely these territories that primarily require targeted epizootiological monitoring for early and effective management of preventive activities.

The failure of heart valve bioprostheses, requiring repeated intervention to replace them, is a serious drawback that narrows the scope of such devices. The present study demonstrates the experimental investigation of a medical device designed to partially solve the problem of repeated interventions on heart valves, primarily with an emphasis on reducing the duration and trauma of such procedures due to the sutureless balloon implantation method of the «valvein- valve» method.Material and methods. The paper presents a series of in silico, in vitro and in vivo experiments to evaluate various aspects of the device under development. Numerical modeling of the final shape setting to the supporting frame of the heart valve prosthesis to select the most promising concept for prototyping was carried out in the Abaqus/CAE (Dassault Systèmes, France) based on the finite element method. The selected optimal support frame model was prototyped in the form of a series of prosthesis samples of four standard sizes for hydrodynamic studies of quantitative characteristics in vitro. The study was carried out in the Vivitro Labs unit (Vivitro Labs, Canada), imitating the physiological mode of the heart, the prostheses were examined for the mitral position. The developed prototypes of the device were supplemented with related products, an implant holder and a balloon catheter, after which the proposed method of sutureless fixation was validated in an in vitro implantation procedure on a bovine heart model and a series of in vivo (n = 3) chronic experiments on animals.Results. In the course of numerical simulation, it was shown that in Model No. 3 of the supporting frame of the prosthesis, the smallest stresses occur – with an amplitude of up to 490 MPa. For other concepts (Models No. 1 and No. 2), this indicator was significantly higher, 543 and 514 MPa, respectively. Prototypes obtained on the basis of the selected shape of the support frame demonstrated satisfactory hydrodynamic characteristics: effective hole area 190-261 mm2, regurgitation volume 6–9 ml/cycle, average transprosthetic gradient 4.4–6.4 mmHg, depending on size. The study of the technology of sutureless balloon implantation in an in vitro model of the heart and the subsequent chronic experiment on sheep confirmed the main idea of the system – the possibility of a significant reduction in the duration of repeated prosthetics. It has been shown that the time of suture implantation of the “classic” frame prosthesis of the mitral valve is 23–29 minutes, with a total access time of 41–52 minutes. When implanting the experimental device, the sutureless prosthesis itself took 4–6 minutes, access time 24–29 minutes. At the same time, one-month results of an echocardiographic study of the operation of the prosthesis demonstrated satisfactory hemodynamics.Conclusions. This work demonstrates a consistent series of tests of the system being developed for repeated heart valve replacement, which substantiates some design solutions, confirms the effectiveness and viability of the chosen approach to sutureless minimally invasive implantation.

The risk of importation of infectious diseases is an urgent threat to sanitary and epidemiological well-being of the population, both at the level of individual countries and interstate associations, and globally. The territory of any country has a backdrop of hazards; therefore, the aim of the work was a comprehensive assessment of risk of infectious disease importation onto the territory of Russia for early and effective response to emerging biological threats. Materials and methods. We used information on the structure of passenger traffic and the number of persons arriving in Russia according to the portal of the Unified Interagency Information and Statistics System. The data on the incidence of infectious diseases which require measures on sanitary protection of the territory of Russia is provided according to the official regional websites of WHO, regional Centers for Disease Control and Prevention (CDC), Ministries of Health of the respective countries. The risk of importation of infectious diseases was estimated in points in compliance with an original methodology developed with the participation of the authors. Results and discussion. We have determined the structure of the passenger traffic across the borders of Russia and the most relevant infectious diseases that pose a risk of importation, as well as the countries, from where the importation of infections is most likely to occur. It is outlined that importation of dengue fever and cholera from the Southeast Asian region, dengue from the Western Pacific region, cholera and malaria from the Eastern Mediterranean region, cholera, malaria and dengue from the American and African regions is most probable.

The aim of the study was to develop methodological approaches to assessing the economic damage associated with the incidence of hemorrhagic fever with renal syndrome (HFRS) and to calculate the economic damage by the example of an outbreak of HFRS in the Saratov region in 2019. Materials and methods. The paper analyzes the economic indicators of the Federal State Statistics Service; data on the incidence of HFRS in the Russian Federation for the period of 2019–2022. To calculate the cost of outpatient and inpatient medical care, as well as the costs associated with the medical follow-up of convalescents, the indicators of the Program of state guarantees of free provision of medical care to citizens for 2022 and for the scheduled period of 2023 and 2024 were used. The calculation of economic losses associated with the payment of temporary disability benefits was carried out according to the equation provided in the Federal Law No. 255-FZ dated December 29, 2006 (as amended on October 07, 2022). Economic losses associated with premature death at an economically active age were calculated based on the value of unproduced GDP due to lost years of life in the corresponding age group. Results and discussion. The costs of treatment, rehabilitation and payment of temporary disability benefits for 1 case of HFRS at the age of 0 to 56.5 years for the female population and from 0 to 61.5 years for the male population amount to 140 495 rubles; over the age of 56.5 years for the female population and 61.5 years for the male population – 95 412 rubles, respectively. Each fatal case of HFRS aged 0 to 16 years among the male population costs the state 38 976 231 rubles; among the female population – 34 708 331 rubles; in active working age – the value of economic damage varies depending on the age of the person who died of HFRS. The economic damage of the outbreak of HFRS in the Saratov Region (2019), taking into account the direct expenditures of the healthcare system and indirect losses of the country’s economy amounted to 441 453 432 rubles. It is of note that the structure of the main damage is dominated by indirect losses in the economy caused by the premature death of people in economically active age.

The paper provides the analysis of epidemiological process of hemorrhagic fever with renal syndrome (HFRS) in the Russian Federation in the context of federal districts in 2022 and a forecast of the HFRS incidence for 2023. According to the results of the analysis, there was a three-fold increase in the morbidity rates of HFRS in Russia in 2022 as compared to the indicators of 2021. The evidence of epizootiological survey and laboratory studies in certain federal districts of the Russian Federation indicate the continuing tense epidemiological situation on HFRS. In a number of regions of the country, high risk of infection with HFRS is predicted due to the favorable natural and climatic conditions of the winter period 2022/2023 for reservoir hosts of pathogenic for humans Hantaviruses. The findings of infected rodents attest to a high probability of complication of the epidemiological situation in the territories of increased epidemic hazard as regards HFRS.

The aim of the work was to assess the epidemic situation on plague in the world and epizootic activity of natural plague foci of the Russian Federation in 2022. Following the implementation of comprehensive preventive interventions plans, there was a decrease in the epizootic activity of the Gorno-Altai high-mountain and Tuva mountain natural foci, the cessation of plague epizootics in the Central Caucasian high-mountain focus. The total area of epizootics in the Russian Federation in 2022 reached 248.3 km2, which is 7 times less than in 2021. Infected animals were not found in the Tersko-Sunzhensky low-mountain, Dagestan plain-piedmont, Caspian North-Western steppe, Volga-Ural steppe, Trans-Baikal steppe, Volga-Ural sandy, Caspian sandy, East Caucasian high-mountain natural foci. Persistence of tense epizootiological situation in 2023 is predicted for the territory of the Altai Republic and the Republic of Tuva. The prospects of using the GIS portal of the Russian Anti-Plague Institute “Microbe” of the Rospotrebnadzor for an operational assessment of the actual epidemiological situation in natural plague foci are substantiated.

Globalization and high-speed means of transportation contribute to the spread of infections dangerous to humans. Airborne pathogens have pandemic potential as currently shown in case of the novel coronavirus SARS-CoV-2. Natural focal Lassa fever (LF) common in West African countries, in 35 cases was registered in non-endemic geographical areas because any person infected with Lassa virus (LASV) is a long-term source of infection (up to two months). Cases of person-to-person infection in endemic territories are described. In Germany, the facts of secondary virus transmission from patients to doctors have been recorded during the examination and blood collection from an apparently healthy person as well as during the autopsy of a deceased subjects due to severe LF course. Nonspecific malaise symptoms in LF are also characteristic of numerous other diseases common on the African continent, e.g., malaria and typhoid fever or viral infections such as yellow fever, Chikungunya, dengue and Zika, monkey pox and Ebola virus disease. In this regard, there may be similar dermatological manifestations. Timely detection of cases and differential diagnosis are crucial to ensure safe patient care and use of affordable antiviral therapy for LL provided by the drug Ribavirin. Research methods for studying LASV use polymerase chain reaction (PCR) for detecting viral RNA, electron microscopy, isolation of infectious virus cultured sensitive cells, indirect immunofluorescence reaction, enzyme immunoassay (ELISA) and immunochromatographic assays for the detection of antibodies and/or antigen as well as immunoblotting. Currently, test kits based on molecular and genetic methods are mainly used for LF laboratory diagnostics. Since the 1980s, ribavirin has been used to treat patients with LF. The serum accumulation of the drug in large quantities causes hemolysis, development of anemia and impaired renal function. In this regard, treatment options are being considered with decline in its concentration due to combined use with other antiviral drugs. A search for new therapeutic agents capable of inhibiting viral replication at disease early stage has been in progress due to lack of any approved vaccines.

Lassa fever is a natural focal disease dangerous for humans. In the larger part of sub-Saharan West Africa 37.7 million people in 14 countries live in areas where living conditions are suitable for zoonotic transmission of the virus from secretions of infected rodents of the species Mastomys natalensis. Routes of transmission can be via alimentary, airborne dust or airborne droplet pathways in case of accidental human contact with secretions of infected rodents. Mastomys natalensis penetrates into residence and place of storage of food and drinking water. In addition, the residents use such animals for food, so infection is also possible upon butchering carcasses. The etiological agent of this disease is the Lassa virus being one of the members of the Arenaviridae family. Unlike other arenavirus infections (e.g., Argentine and Bolivian fevers caused by Junin viruses and Machupo, respectively), human infection with Lassa virus can also occur from person to person. Cases of nosocomial infection among patients in conditions of poor hygiene and through contaminated medical equipment are described. Medical workers become infected during surgical operations or through contact with patients, because the pathogen can be transmitted via blood, saliva, vomiting, stool or urine. In endemic territories, Lassa fever is associated with significant morbidity, because 500 thousand clinical cases and due to 5 to 10 thousand fatal outcomes of this disease are registered annually (i.e. 12% mortality). The likelihood that this disease will become a more widespread threat worldwide may be associated with increased globalization as well as climate change leading to the expansion of the Lassa fever endemic zone into regions suitable for the settlement of M. natalensis and other rodent species capable of lifelong pathogen carriage. Among hospitalized persons with severe hemorrhagic symptoms, the mortality rate can be very high ranging from 14 to 89.5%. But in the majority of cases, the disease proceeds asymptomatically, and due to its long-term incubation period all ill subjects may be a source of infection, especially travelling at long distance by plane or train. Clinically evident disease occurs in the form of various nonspecific symptoms from malaise, fever, sore throat and chest, cough, myalgia and gastrointestinal disorders to signs of central nervous system disorders. The diagnosis of Lassa fever is often difficult due to the similarity of its course with other viral diseases common in Africa or malaria or typhoid fever. More specific symptoms for Lassa fever are revealed as conjunctivitis, hepatitis, pharyngitis, tonsillitis as well as developing oropharyngeal ulcers. Severe disease is complicated by abnormal bleeding, generalized edema, respiratory failure, hypotension, proteinuria, transaminitis, encephalopathy. Deafness develops in about 20% of cases. Multiple organ failure and open bleeding lead to death. The review is devoted to analyzing publications on the etiology, epidemiology and clinical picture of Lassa fever due to a threat of its importation with sick subjects to the territory of the Russian Federation.

Cardiotoxicity is a side effect of anthracycline-based chemotherapy. Clinical and prognostic significance of left ventricular diastolic dysfunction in heart failure patients is undeniable.The aim. To assess dynamic changes in the left ventricular diastolic function after anthracycline-based chemotherapy (ANT) in breast cancer patients.Material and methods. The study included 40 women aged 35 to 72 years with breast cancer (BC) undergoing ANT chemotherapy. The main group (n = 40) consisted of women with breast cancer examined at admission, after 6 months the same women (n = 37) were examined again. Women without breast cancer (n = 25) were used as the control group.Results. Dynamic changes in mitral annular velocities were revealed by Doppler tissue imaging. Lateral early diastolic mitral annular velocity (e’ lateral) was significantly lower in breast cancer patients as compared to the control group (p = 0.031). Six months after ANT chemotherapy, there was a definite increase in the lateral late diastolic mitral annular velocity (a’ lateral) (p = 0.033). Average early diastolic transmitral flow velocity to early diastolic velocity (E/e’ lateral) ratio was within the normative values in all groups, but E/e’ lateral in the main group was higher compared to the control group (p = 0.003). In the main group, septal early diastolic mitral annular velocity (e’ septal) was lower compared to the control group (p = 0.0005). Moreover, an increase in the septal mitral annular velocity (a’ septal) (p = 0.01) and higher E/e’ septal ratio (p = 0.011) were revealed during dynamic observation. Multiple logistic regression disclosed that E/A, e’ lateral, e’/a’ lateral, and E/e’ lateral were affected by heart rate, psychological status, age, hypertension, and body mass index, but not anthracycline chemotherapy. The total dose of anthracycline was independently associated with e’ septal and E/e’ septal: F(4.18) = 16.466 (p < 0.001; R2 = 0.775) and F(3.16) = 7.271 (p = 0.004; R2 = 0.627).Conclusion. Left ventricular diastolic function worsens in women undergoing anthracycline-based chemotherapy for breast cancer (lower e’, e’/a’ lateral, and e’ septal, higher E/e’ septal ratio). However, anthracycline does not significantly affect LVEF and LV deformation indicators. E/e’ septalande’ septal are independently associated with the total dose of anthracycline.

Purpose: to analyze the results of a survey aimed at assessing the patients’satisfaction with the results of excimer laser or orthokeratological correction of myopia. Materials and methods. 135 patients aged 35 to 50 took part in a satisfaction survey: 105 after excimer laser and 30 after orthokeratological correction of myopia. Excimer laser surgery was performed with planned binocular hypocorrection within -0.75 — 1.5 D depending on age. To participate in the survey, the patients signed a preliminary consent. The questionnaire asked for age, gender, occupation, self-assessment of visual functions under a variety of conditions (vision at dusk, at close distance, at far distance, while driving a vehicle, etc.), self-assessment of satisfaction with the result. The questionnaire required to answer 15 questions on a multiplechoice basis. Results. Over 50 % of the patients have no difficulty working at close distance, at far distance, or when driving a vehicle, and do not restrict themselves in professional or everyday activities. More than 90 % of the patients would recommend excimer laser correction in binocular format with a planned hypo effect or orthokeratological correction to others. 125 out of 135 patients gave the maximum satisfaction score points. Conclusion: excimer laser correction of myopia with a planned hypoeffect in binocular format and orthokeratological correction can be recommended for patients over 35.

The aim of the work was information-analytical assessment of the epidemiological situation on infectious diseases that are potentially or truly dangerous in terms of occurrence of emergencies of sanitary-epidemiological nature in the Region of Americas.Materials and methods. The study was based on the official reports of the WHO, the Pan American Health Organization, the Centers for Disease Control and Prevention, the national Ministries of Health, data from the ProMED information portal, the Global Network for the Epidemiology of Infectious Diseases, and published scientific papers.Results and discussion. By the model of the Americas, regional epidemiological features have been established, including the endemicity (enzooticity) of territories according to the most relevant nosological forms and the intensity of the epidemic process manifestations. It is shown that the main epidemiological risks in the countries of Central, South America and the Caribbean are associated with dengue, Zika, Chikungunya fevers characterized by a wide territorial dissemination and the ability to cause large-scale epidemic outbreaks, in the countries of North America – West Nile fever. Other infections of international concern include: cholera, that twice caused epidemics of imported origin during the seventh pandemic, which changed the structure of world morbidity; plague, manifested in an annual incidence, including with a complication by the pneumonic form, which determines an increased potential danger of anthropogenic spread; malaria, demonstrating an upward trend in morbidity and the number of intra-continental imported cases; yellow fever, characterized by the activation of natural foci and the expansion of the territories of potential pathogen transmission. The data obtained can serve as a basis for assessing the risks of infectious disease introduction from the American Region into safe territories, improving epidemiological forecasting and validity in making managerial decisions when conducting sanitary and anti-epidemic (preventive) measures.

The paper presents a description of the epidemiological situation on Hantavirus infection incidence in the countries around the world. Comparative analysis of the intensity and dynamics of the epidemiological process of hemorrhagic fever with renal syndrome (HFRS) in the Russian Federation by Federal Districts in 2021 has been carried out and forecast of the HFRS incidence for 2022 prepared. The study has revealed that tense situation on incidence of hantavirus diseases was observed in the world in 2021. On the territory of the Russian Federation, there was a decrease in the HFRS incidence in 2021 (by 1.7 times compared to 2020). However, the results of epidemiological analysis of the HFRS incidence, epizootiological data and laboratory studies in certain Federal Districts of the Russian Federation indicate that the epidemiological situation on HFRS remains tense. High risk of HFRS infection is predicted in a number of regions of the country due to the favorable natural and climatic conditions in the winter period of 2021–2022 with a heavy snow cover, which contributed to the under-snow reproduction of small mammals, the main carriers of HFRS. The presence of infected rodents testifies to a high likelihood of complication of the epidemiological situation in areas of increased epidemic risk of HFRS.

The aim of the research was to assess epizootic activity of natural plague foci in the Russian Federation in 2021 and provide a prognosis for 2022. Activation of epizootic process has been detected in Central-Caucasian high-mountain natural plague focus after a recess since 2007. Local epizootics persist to develop in Tuva Mountain and Gorno-Altai highmountain plague foci. Total area of epizooties in Russia in 2021 amounted to 1649.5 km2. 28 plague microbe strains were isolated. Animals infected with plague were not found in Tersko-Sunzhensky low-mountain, Dagestan plain-piedmont, Precaspian north-western steppe, Volga-Ural steppe, Trans-Baikal steppe, Volga-Ural sandy, Caspian sandy and EastCaucasian high-mountain natural plague foci. It is demonstrated that epidemiological welfare as regards plague in Russia in 2017–2021 was achieved through annual epizootic monitoring of plague-enzootic territories, timely epizooty detection and preventive activities aimed at reducing the risk of infection. Substantiated has been the forecast for tense epidemiological situation on the territory of Karachay-Cherkessia, Kabardino-Balkaria, Altai Republic and Tuva Republic in 2022. A new Epitracker application has been proven to be prospective for rapid assessment of actual epidemiological situation in natural plague foci.

Purpose: to evaluate the wave-front and accommodation changes in various stages of keratoconus corrected by scleral contact lenses.Material and methods. 20 patients (39 eyes) aged 18–37 with keratoconus of various stages (8 eyes with stage I, 3 eyes with stage II, 12 eyes stage II/III and 16 eyes with stage III wore OneFit or OneFitMed scleral lenses, made of hard gas-permeable material Contamac (Great Britain) with Dk 100 and mean thickness of 200–220 μm. All patients were examined using refractometry before and after cycloplegia, tested for uncorrected and best corrected visual acuity, relative accommodation reserve (RAR), binocular and monocular accommodation response (with Grand Seiko Binocular Open Field Autorefkeratometer WR-5100K, Japan) for full spectacle correction and scleral contact lens correction. 17 patients (34 eyes) were tested for corneal aberrations with OPD Scan III aberrometer (Nidek) without correction and with scleral contact lenses.Results. Patients with keratoconus demonstrated a manifest form of refraction -5.26 ± 0.45 D (by sphere equivalent) and a cycloplegic refraction of -4.75 ± 0.33 D. Uncorrected visual acuity averaged 0.26 ± 0.05, increasing with full spectacled correction to 0.54 ± 0.07 and with scleral contact lenses correction to 0.95 ± 0.08. Keratoconus patients demonstrated binocular accommodative response (BAR) of +4.5 to -6.12 D averaging -1.43 ± 0.34 D with full spectacled correction diopters and of -0.5 to -8.13 D averaging - 2.83 ± 0.23 D with scleral contact lenses, р ≤ 0.01. We could not measure the BAR in 3 patients with keratoconus stage III. Monocular accommodative response (MAR)with a full correction with glasses averaged -0.98 ± 0.33 D (from + 6.0 to -5.0 D) with full spectacled correction and -2.41 ± 0.27 D (from +1.25 to -5.5 D) with scleral contact lenses, р ≤ 0.02. At the same time monocular accommodative response of 4 patients with keratoconus of the third stage of disease was not available to assess. So, accommodative response significant increased with scleral contact lenses. Positive relative accommodation with a full correction with glasses averaged 1.50 ± 0.35 D, with scleral contact lenses – 2.25 ± 0.29 D, р ≤ 0.01. The level of all aberrations, from lower to higher orders was significantly increased. With scleral contact lenses that correct the shape of the anterior surface of the cornea, the level of all corneal aberrations dropped to nearly normal values, while the coefficient of asphericity dropped below normal values, and the point spread function parameter (PSF) increased by fifteen times (to reach 0.06).Conclusions. Patients with keratoconus demonstrated a generally lower objective accommodative response as compared to normal values, but with the scleral lenses it increases to the normal level. Scleral contact lenses normalize corneal aberrations and increase the quality of vision. All of the above justifies the recommendation to use scleral contact lenses for optical correction of keratoconus to increase the vision, the accommodation response and visual comfort, including that of near-visual work.

The review presents generalized epidemiological data and the situation on infectious diseases requiring measures for the sanitary protection of the territory of the Russian Federation in the countries of the European Region of the World Health Organization (WHO). The epidemiological analysis was carried out using data from the official websites and periodicals of WHO, the WHO European Office, the ministries of health of countries, the European Center for Disease Prevention and Control, other international organizations, as well as materials from publicly available publications. The review summarizes and systematizes data on the incidence and territorial distribution of diseases in each specific country from the standpoint of possible risks for people visiting it. The presented data on infectious diseases make it possible to navigate through issues related to the risk of contracting infectious diseases, to determine the factors and seasonality of an increased risk of infection, and to predict the possibility of importing diseases into the Russian Federation.

Purpose: to evaluate the prospects of customized Finalfit based ablation for optical rehabilitation of a patient with corneal surface errors caused by intrasurgical microtome-induced damage of a corneal flap during a LASIK excimer laser correction of vision.Material and methods. In Helmholtz Center, a patient with such damage was given a phototherapeutic keratectomy (PTK) combined with topographyguided photorefractive keratectomy.Results. In two months after the surgery, the patient’s uncorrected visual acuity rose from 0.15 to 1.0; the spherical component of refraction changed from -3.5 to +1.0 D, the cylindrical component of refraction fell from 1.75 to 0.25 D. Aberrometry demonstrated a decrease of RMS from 2.19 to 0.61 D, Total HOAs from 2.281 to 0.829; Tilt from 0.406 to 0.313; HOA from 1.152 to 0.247, Coma from 0.298 to 0.124, Trefoil from 1.088 to 0.094, SA from 0,127 to 0,021.Conclusion. The clinical case demonstrates the expediency and efficiency of corneal remodeling for the rehabilitation of induced errors of the corneal surface by excimer laser correction of vision based on PTK (Flex scan) + FinalFit after corneal refractive surgery.

The review used the data from operational monitoring carried out by the Reference Center for Monitoring over HFRS – “Kazan Research Institute of Epidemiology and Microbiology of the Rospotrebnadzor”, based on official data provided by the Rospotrebnadzor institutions in the constituent entities of the Russian Federation. Statistical processing was conducted using conventional methods of variation statistics applying the Excel program. Over the past decades, hantavirus diseases have become very relevant and spread throughout the world. In the territory of the Russian Federation, natural foci of HFRS are located in the European part of the country, Western Siberia and Far East. The most epidemically active foci are situated in the European part of Russia. Over the past decade, the intensive incidence rate of HFRS in the Russian Federation stayed within the range of 3.0–9.5 per 100 thousand of the population, the long-term average annual indicator – 5.2 per 100 thousand of the population. In 2020, 3845 cases of HFRS were registered (2.62 per 100,000 of the population). There was a decrease in the incidence of HFRS by 3.6 times, compared with the indicators of 2019. A factor that may have influenced the decrease in the incidence of HFRS was the depression of the epizootic process among small mammals, the main carriers of HFRS pathogens, due to natural and climatic factors. The nature of the distribution of HFRS incidence across the territory of the Russian Federation in 2020 was heterogeneous. Statistical processing of the data made it possible to identify 5 groups of territories that differ in the level of HFRS incidence. Almost all constituent entities of the Volga Federal District and the Kostroma Region belonging to the Central Federal District were classified as groups of territories with high and very high incidence rates. In 2021, the deterioration of the epidemiological situation is predicted in the summer-autumn period of the year in the Volga Federal District and four entities of the Central Federal District.

Purpose: a covariance analysis of the planned and actually obtained refraction after excimer laser myopia correction surgery in middle-aged patients. Material and methods. 85 patients (170 eyes) aged 35 to 50 underwent excimer laser myopia correction surgery by FemtoLASIK. The patients were divided into 3 groups according to the degree of myopia: group 1 included 13 patients (26 eyes) with myopia from -1.25 to -3.0 D, group 2 had 42 patients (84 myopic eyes) from -3.25 to -6.0 D and group 3 had 30 patients (60 eyes) with myopia of -6.25 D or higher. Results. The patients with low myopia, independently of the age, revealed a postoperative refraction effect closer to that planned than the patients with moderate and high myopia. The difference (delta) between the planned and the obtained results was -0.35 ± 0.08 D (41%) in group 1, -0.58 ± 0.04 D (51.3%) in group 2 and -0.64 ± 0.05 D (46%) in group 3. The divergence between the respective indicators for figures for low and high myopic groups is statistically significant. Conclusion.Patients with low myopia over 35 years old can be recommended a symmetric hypocorrection in binocular format irrespective of the objective data regarding the initial corneal hydration, which affects the ablation volume. To achieve a better agreement between the planned and the actual hypoeffect (and, accordingly, a more precise dosage of the surgery) in patients with moderate and high myopia, it is important to introduce into clinical practice the technology of contactless measurement of corneal hydration.

The purpose of this review is to characterize the current epidemiological and epizootiological situation in natural foci of hantavirus diseases in different regions of the world, and to analyze the literature data available. Currently, hantavirus diseases are a very urgent threat to the sanitary and epidemiological well-being of the population around the world, which can cause serious complications of the epidemiological situation. About 200 thousand cases of the disease are registered every year around the world, while the intensity and dynamics of the incidence varies significantly in different regions of the world. While in China – the country with the largest annual number of cases worldwide – the overall dynamics of the incidence has a downward trend, which is apparently due to the widespread use of specific disease prevention tools; the number of cases in European countries, on the contrary, shows a clear increase. In the Russian Federation, hemorrhagic fever with renal syndrome (HFRS) is currently the most common natural-focal disease of viral etiology. Data on the prevalence of hantavirus infection in the regions of South-East Asia and the African continent require further investigation, but it is quite obvious that hantavirus infection is a very underestimated public health issue in these regions, and its scale, due to the wide spread of carriers, may be much more considerable than is currently known.

The aim of the work was to substantiate the forecast of the epidemiological and epizootiological situation in natural foci of plague in the Russian Federation, countries of the near and far abroad for the year of 2021. Characteristics of the distribution of Yersinia pestis strains of the main subspecies (subspecies pestis) of medieval and antique biovars, Caucasian (ssp. caucasica) and central Asian (ssp. central asiatica) subspecies by 45 natural foci of the CIS countries are presented in the paper. The persistence of a multidirectional trend in the dynamics of epizootic activity of natural foci of the CIS countries with the circulation of Y. pestis pestis strains of the medieval biovar of the 2.MED1 phylogenetic branch and the antique biovar of the 0.ANT5, 4.ANT phylogenetic branches in the current decade has been outlined. For the Russian Federation, the development of epizootics is predicted in the Gorno-Altai highland and Tuva mountain natural foci caused by the circulation of Y. pestis pestis strains of the antique biovar 4.ANT and Y. pestis of the Altai biovar of the Central Asian subspecies 0.PE4a in 2021. For the Republic of Kazakhstan, there is a high probability of preserving epizootic activity in the North Aral, Aral-Karakum, Balkhash, Mojynkum, Taukum desert and Ili intermountain natural foci with the circulation of Y. pestis pestis strains of the medieval biovar of the phylogenetic branch 2.MED1. For the Kyrgyz Republic, the forecast for the development of plague epizootics caused by Y. pestis pestis strains of the antique biovar 0.ANT5 phylogenetic branch in the Sarydzhaz and Upper Naryn high-mountain natural foci has been substantiated. A high epidemic risk of epizootic manifestations caused by highly virulent strains of Y. pestis pestis of antique biovars 0.ANT5, 4.ANT and medieval biovar 2.MED1 for the entire territory of the CIS countries is noted. The relevance of implementing forecasts of the epidemiological situation into practice, taking into account the molecular-genetic and epidemiological characteristics of Y. pestis strains circulating in areas of expected epizootic manifestations of plague, is highlighted.

Aim. To assess the right ventricle (RV) during chemotherapy (CT) in patients with breast cancer (BC).Material and methods. The study included 40 women aged 35-72 years with BC who underwent anthracycline chemotherapy. The main group (n=40) included women with BC, examined at the first contact, 37 of whom were reexamined after 6 months. Control group (n=25) included women without BC.Results. In the main group, the median transverse dimension and anterior wall thickness of the RV were significantly greater than in the control group (p

Aim. Production of recombinant viral antigens of the main immunodominant proteins: glycoprotein (GPΔMLD), nucleoprotein (NP) and matrix protein (VP40) of the Marburg virus, as well as the study of their antigenic and immunogenic properties.Materials and methods. To create recombinant proteins GPΔMLD, NP and VP40 of the Marburg virus, synthesized nucleotide sequences encoding these proteins cloned into the pET21a expression vector were used. The immunogenic and antigenic properties of the obtained recombinant proteins were tested using a number of biomodels (mice, chickens, and guinea pigs).Results and discussion. Recombinant plasmids containing genes encoding proteins GPΔMLD, NP, VP40 of the Marburg virus, as well as Escherichia coli producing strains, with the yield of purified preparations of recombinant proteins GPΔMLD, NP, VP40 from one liter of culture fluid – 5, 10, and 10 μg were obtained, respectively. When mice are immunized, recombinant proteins GP, NP, and VP40 MARV induce the synthesis of high titer antibodies (recombinant proteins NP and VP40 – more than 409600, and recombinant protein GPΔMLD – 12800). Mouse antibodies specific to recombinant proteins interact in an enzyme-linked immunosorbent assay (ELISA) with the antigen of inactivated MARV. Antibodies of chickens immunized with virus-like particles containing the surface glycoprotein of the Marburg virus and antibodies of guinea pigs immunized with an experimental DNA vaccine containing the GPΔMLD MARV gene recognize the recombinant GPΔMLD protein and the viral protein in the inactivated MARV. The resulting recombinant proteins are immunogenic/antigenic and can be used for the development of enzymelinked immunosorbent assay systems.

The article presents the performance indicators of the drug treatment service in the Russian Federation. The incidence of cannabinoid and designer drugs is growing, and so is the so-called poly-drug addiction. Thus, the value-semantic sphere of the personality of patients with poly-drug addiction requires more extensive research. The present study proved that such patients have very low awareness of personal experiences, current life situation, and goals. The poly-drug patients demonstrated a diffuse hierarchy of value orientations and a low level of comprehension of the past, present, and future values. Their valuesemantic sphere was of a malignant nature and collapsed much faster than in patients with alcoholism. The paper focuses on the psychological support of patients with drug-related disorders at the stage of rehabilitation. As part of tertiary prevention, the program of psychological support can be based on methodological principles of the value-semantic sphere of personal development. This approach makes it possible to focus the rehabilitation process on rethinking the values of personal experience, real-life situation, and future goals. The article also introduces various levels of psychological assistance, based on the rehabilitation program realized at the Kuzbass Clinical Narcological Dispensary.

The purpose of the study: analysis of medical and social problems and factors affecting the availability and compliance of a gluten-free diet, based on a survey of parents of children with celiac disease living in southern Russia. Purpose of the Study: Analysis of the medical and social problems and factors affecting the availability and adherence to the gluten-free diet based on the results of the questioning survey of the parents of children with celiac disease that are residents of the south of Russia. Children Characteristics and Study Methods. The study include 200 families that bring up the children with the celiac disease at the ages from 10 months to 18 years. The patients included 116 (58%) girls and 84 (42%) boys. The medical and social issues were studied using the developed questionnaire consisting of the open questions and intended as self-administered by the patient parents. Results. 87% of the families noted the significant difficulties in adhering to the diet, 75% were forced to refuse to travel with children, 56% of the surveyed were unable to visit the public spaces, restaurants, and 90% indicated the impossibility and difficulties in purchase of the gluten-free products. The strict adherence to the diet at school age is much worse. The main reasons for the deliberate non- adherence to the gluten-free diet are the high cost of food, lack of funds to purchase it. The patient families spend RUB 8,000– 9,000 per month in average to purchase the gluten-free products. There is a great demand of patients for the imported products with the relevant quality marks. The psychological symptoms were noted in the patients with celiac disease in response to the introduction of the gluten-free diet, manifested by the depression, aggression, irritability, high level of the anxiety. Conclusion. The main difficulties faced by the families that bring up the children and adolescents with the celiac disease include the social and psychological maladjustment of the patients, reduced finances, search and purchase of the high-quality gluten-free products and the necessity to adapt the child and family members to the dietary habits.

Objective is to reduce the risk of infection of people with plague in the territory of a natural focus on the basis of the targeted public health educational work with risk groups.Materials and methods. In 2017, 30 visits were made by epidemiological groups to livestock farms in the epizootic zone to inform the population about the existing risks of plague infection and to conduct interviews to assess the level of alertness regarding the risk of the disease. Work was carried out with risk contingents with coverage of 1652 people (81% of the total number of people living in livestock camps).Results. It was found that 64% of the respondents knew about the danger of plague infection in the region. 91% are aware of the role of marmots in infecting people with plague. 96.3% of respondents are aware of the ban on hunting groundhogs, while 39% continue to prey upon the grey (Altai) groundhog. The identified gaps in the population’s alertness regarding the risk of plague infection were eliminated through active sanitary and educational work with the population.Conclusion. Direct work with the population, anti-epidemic groups, significantly affected the provision of epidemiological welfare as regards plague, which is confirmed by the absence of human plague cases in the natural focus in 2017-2019.

Aim. To evaluate the effectiveness of a comprehensive prehabilitation program including the optimization of drug therapy for patients undergoing elective coronary artery bypass grafting (CABG).Material and methods. 56 male patients with stable angina referred to elective on-pump CABG were enrolled in a study. All patients were screened for eligibility according to the inclusion/exclusion criteria and then randomized into two groups. Group 1 patients (n=28) underwent preoperative management (prehabilitation) for 14 days, including patient education and physical rehabilitation. Trimetazidine in a dose of 80 mg per day was added to the standard drug therapy. Group 2 patients (n=28) underwent similar preoperative management, but with the standard drug therapy without trimetazidine. In addition to the routine methods of preoperative management, all patients underwent the 6-minute walk test (6MWT) to assess exercise tolerance and speckle tracking echocardiography to measure left ventricular (LV) longitudinal deformation. Serum troponin T was measured in all patients. The measurements were performed at admission and after the surgery.Results. Patients did not differ in the main clinical and demographic data, as well as the main preoperative speckle tracking echocardiography findings. The intraoperative parameters were comparable in both groups. The rate of early postoperative complications was 61% (n=17) in Group 1 and 64% (n=18) in Group 2 (p>0.05). LV ejection fraction significantly decreased postoperatively in both groups (p

Introduction. Coeliac disease is a genetically determined disease associated with the HLA-DQ2 and DQ8 genes. According to European data, these alleles are detected in more than 95% of patients. The results of earlier studies in various regions of the Russian Federation and the constituent republics have shown a lower incidence of HLA-DQ2/DQ8 in children with coeliac disease (60–80%). These data served as a basis for discussion about regional genetic features and the potential for disease development in a significant proportion of patients without DQ2/DQ8 alleles.Methods. Genetic screening was conducted on 275 children with coeliac disease. According to the results of the study, the patients were assigned to genetic risk groups.Results. HLA-DQ2/DQ8-alleles were detected in 274 children (99.6%), with 86.9% of patients having DQ2 molecule in genotype and 12.7% having DQ8 molecule. Among 239 DQ2-positive patients, 33.5% were DQ2 homozygous. The remaining DQ2-positive patients had the following HLA-DR-DQ allele distribution: DR3-DQ2/DR5-DQ7 – 8.7%, DR7-DQ2/DR5-DQ7 – 13.4%, DR3-DQ2/ DRx-DQx – 22.2%, DR7-DQ2/DRx-DQx – 2.2%. In five children the incomplete DQ2 molecule was determined, represented by DQA1*0501 allele, while in four patients DQA1*501 was associated with DQB1*0301 allele forming DR5-DQ7 molecule. We found high and significant risk alleles in 29.1% and 22.2% of cases, while moderate and low risk alleles were found in 27.3% and 21.4% of cases respectively.Conclusions: In Russian children with coeliac disease the prevalence of HLA-DQ2/DQ8 alleles corresponds to European data. Low detection frequency of HLA-DQ2/DQ8 molecules in Russian coeliac patients, which was reported earlier, may be due to peculiarities of the approach to the disease diagnostics, which do not correspond to modern Russian and international recommendations.

Objective of the review is to characterize the nature of epidemiological situation on HFRS around the world and to conduct a comparative analysis of intensity and dynamics of the epidemiological process in the Russian Federation by Federal Districts, as well as make forecast for 2020. The analysis of the epidemiological situation is based on the materials of the official websites of healthcare organizations in the USA and Europe, WHO, the data from operational monitoring carried out by the reference center for HFRS monitoring “Kazan Research Institute of Epidemiology and Microbiology”, materials provided by the Rospotrebnadzor Institutions in the constituent entities of the Russian Federation. The analysis included all administrative territories of the Russian Federation. Statistical processing was carried out by standard methods of variation statistics applying Excel software. The epidemiological situation on hemorrhagic fever with renal syndrome around the world and in Russia remains tense. In the Russian Federation, epidemically active foci are located in the European part of the country, in Western Siberia and in the Far East. Infections over the period of 2010–2019 were registered in 8 federal districts of the Russian Federation, in 58 constituent entities. However, the incidence distribution across the territory of the country was differential. In 97 % of the cases, the incidence was recorded in the European part of Russia. In the Volga Federal District, HFRS incidence amounted to 82.16 % of the total incidence recorded on the whole in Russia. High incidence rates are also recorded in the Central Federal District (CFD). Over the past 10 years (2010–2019), there has been an increase in the incidence of HFRS in the Central and North-West Federal Districts, and a decrease in the incidence in the Ural and Far Eastern Federal Districts. Varying degree of anthropogenic impact on the natural HFRS foci and climate change manifested in increased ambient air temperatures are of great importance for the spread of HFRS over the past decade. At the end of the review the forecast of the development of the epidemiological situation on HFRS in the Russian Federation for 2020 is presented.

Objective of the study was to identify epidemiological peculiarities of HFRS outbreak in the territory of the Saratov Region in 2019 and to determine the key factors contributing to the intensity of epidemic process.Materials and methods. Analyzed are the data on 2702 cases of HFRS registered in the territory of the Saratov Region in 2019, obtained from the Rospotrebnadzor Administration in the Saratov Region and Center of Hygiene and Epidemiology in the Saratov Region. The basic method of investigation was epidemiological one with application of advanced information technologies.Results and discussion. Retrospective analysis of epidemic HFRS manifestations in the Saratov Region showed that HFRS outbreak of 2019 was the largest over the period of disease reporting, both by the number of cases (2702) and by the duration. Early onset of increase in the incidence (may) and allocation of the majority of cases to the territory of the natural park “Kumysnaya Polyana”(75 %) should be considered as characteristic features of the outbreak. We have conducted epidemiological zoning of the Saratov Region allowing for dividing the Region into four types of territories which differ by the level of risk of HFRS exposure (very high, high, medium, and low), as well as distinguishing the most hazardous in terms of HFRS infection territories of Saratov. The key factors affecting the surge in HFRS cases were high numbers of infected rodents during spring months of 2019 due to mild and extremely snowy winter of 2018–2019; reduction in forest engineering works aimed at turning the focal territory into aesthetic forestry. The change in the character of exploitation of 9 % of the natural park “Kumysnaya Polyana” resulted in the increase of population contacts with natural-focal complexes. Mass visits to natural focus during early spring period against the background of low alertness to risks of HFRS infection led to explosive growth of HFRS incidence.

The review presents the analysis of the data on the spread of COVID-19 around the world and in Russia available as of June 15, 2020. Dynamics and geographical dissemination of COVID-19 in the Russian Federation is considered. The structure of incidence by gender and age is presented. Assessment of the key epidemiological parameters (morbidity rates and lethality) is provided. The effectiveness of the response measures conducted to control COVID-19 is discussed.

Objective of the investigation was to assess epidemiological and epizootiological conditions in natural plague foci of the Russian Federation, neighboring states and foreign countries in 2019. Negative effect of the current climate warming on the state of parasitic systems of natural foci with circulation of plague microbe of the main subspecies, medieval biovar, phylogenetic branch 2.MED1 is emphasized. In 2019, local plague epizooties were registered in the territory of two (Gorno-Altai high-mountain and Tuva mountain) out of 11 natural plague foci of the Russian Federation. The total area of epizooty covered 2248.5 km2 . All in all, 31 cultures of Y. pestis of the main subspecies, antique biovar, phylogenetic branch 4.ANT and 5 cultures of Altai biovar, central-asian subspecies, phylogenetic branch 0.PE4a were isolated. The forecast for continuing tense epidemiological situation, both for 2020 and for 2021–2025, has been substantiated for natural foci with circulation of the main subspecies of antique biovar, phyologenetic branch 4.ANT: Gorno-Altai high-mountain and Tuva mountain ones. In the remaining nine natural foci in the territory of the Russian Federation epizootic manifestations of plague in 2020 are highly improbable. This prognosis is an indication to optimize the deployment of human and logistical resources of plague control institutions through concentrated preventive activities in the territories of epizootically active natural plague foci. Otlined is the necessity to put a new enhanced classification of Y. pestis into practice.

HFRS is a relevant threat to the sanitary-epidemiological welfare of the population of the Russian Federation. It takes a leading position in the structure of natural-focal ifections of viral etiology incidence around the country. The most unfavorable situation on HFRS morbidity rates (more than 80% of the overall incidence) is observed in the constituent entities of the Volga Federal District (VFD). The purpose of the work is to differentiate the territory of the Volga Federal District in terms of the potential epidemic hazard (PEH) of HFRS infection. Materials and methods. We used information on the HFRS incidence contained in the statistical reporting form No. 1 “Information on infectious and parasitic diseases” and the data on epizootic activity of natural HFRS foci from the established forms of surveys and forecasts of the state of population and the numbers of small mammals over the period of 2014-2018. The assessment of the PEH level of HFRS infection was carried out according to the original method developed with the participation of the authors. The software used was the analytical platform Deductor Professional and the geo-information system Arc GIS. Results and discussion. Among the constituent entities of the Volga Federal District an extremely high level of risk of HFRS infection (6 points), the first type of territories, was established for the Udmurt Republic, the Republics of Bashkortostan, Tatarstan, Mordovia, and Chuvash Republic. The second type of territories characterized by high level of risk, where the PEH was 5 points – Samara, Ulyanovsk, Nizhny Novgorod, Kirov, Saratov, Orenburg regions and the Republic of Mari El. The territories in which there is an increased risk of HFRS infection cover the territory of the Penza Region (PEH – 4 points). The average risk of infection was noted only in the Perm Region (PEH – 3 points). Prompt implementation of a complex of nonspecific preventive measures at sites with a pronounced increase in the potential epidemic hazard of HFRS infection will significantly reduce the incidence rate in the VFD and the Russian Federation as a whole.

Purpose: to evaluate the efficiency of simultaneous topography-guided photorefractive keratectomy (PRK) with accelerated collagen cross-linking in the treatment of stage I keratoconus.Material and methods. 38 patients (49 eyes) aged 18 to 44 with stage I keratoconus were treated with simultaneous topography-guided PRK combined with accelerated corneal collagen crosslinking. Along with standard ophthalmological testing, patients underwent aberrometry, confocal microscopy, optical coherence tomography of the cornea, imaging of the anterior eye section on a Scheimpflug analyzer, and examination of the biomechanical properties of the cornea. The follow-up period was 2 years.Results. Two years after surgery, uncorrected visual acuity which originally was 0.23 ± 0.03 showed a statistically significant increase and reached 0.72 ± 0.02; best corrected visual acuity improved from 0.44 ± 0.03 to 0.89 ± 0.02; the refractive power of the cornea fell from 45.03 ± 0.28 to 42.55 ± 0.31 D; the spherical component of refraction reduced from -2.00 ± 0.19 to -0.73 ± 0.09 D; the cylinder component reduced from 2.46 ± 0.14 to 0.79 ± 0.07 mm, the thinnest point of the cornea reduced from 486.30 ± 4.78 to 406.80 ± 6.51 μm. The highest order aberrations showed the following results: Coma index reduced from 0.27 ± 0.12 to 0.08 ± 0.07, Tilt reduced from 0.53 ± 0.11 to 0.10 ± 0,09, and Trefoil reduced from 0.13 ± 0.04 to 0.05 ± 0.02.Conclusion. The analysis of clinical and functional results, biomechanical properties and structures of the cornea confirmed the efficacy and safety of the combined treatment of patients with stage I keratoconus.

Aim. To assess the correlation of fibrosis biomarkers with parameters of diastolic function (DF) in assessing global longitudinal strain in patients with ST-segment elevation myocardial infarction (STEMI) and preserved left ventricular ejection fraction (EF).Material and methods. We examined 50 patients (100%) with primary STEMI and preserved LVEF at the end of hospitalization. On the 1st day of MI, standard diagnostic investigations were carried out. On the 12th day, the serum concentration of procollagen type I carboxy-terminal propeptide (PICP), N-terminal propeptide of procollagen type III (PIIINP), and galectin-3 was determined, as well as echocardiography was performed to assess left ventricular DF. After 1 year, all participants underwent reassessment of PICP, PIIINP, and galectin-3 serum levels. Echocardiography was also performed with an assessment of DF and LV global longitudinal strain.Results. According to speckle-tracking echocardiography, LV global longitudinal strain was visualized in 30 patients (60%), who were included in the final analysis. In the rest of the patients (40%), the limitations did not allow the technique to be performed. During the hospitalization, signs of diastolic dysfunction (DD) were detected in 5 (16,6%) patients; after 1 year, their number increased by 7 (23,3%). During the 1-year follow-up, the total number of patients with echocardiographic signs of DD was 20 (67%). At the same time, global strain parameters indicated the presence of DD in 23 (77%) patients. However, comparison of the incidence of DD according to echocardiography and using the speckle-tracking technology did not show significant differences (p=0,283). Throughout the entire follow-up period, the concentration of the studied fibrosis markers significantly exceeded the control group values. We recorded associations of global strain parameters with biochemical markers of fibrosis and LV DF indicators.Conclusion. Fibrosis biomarkers (PICP, PIIINP, galectin-3), assessed in the subacute period of MI in patients with preserved EF, correlated with indicators of global myocardial strain, which indicates the potential value of their determination for predicting and detecting DD in the postinfarction period.

This review is devoted to the analysis of the literature data on the development of tools for diagnostics of Zika fever and detection of etiological agent – Zika virus (ZIKV) belonging to the Flaviviridae family. Preventive vaccines and antiviral drugs are also considered. RT-PCR method is critical for confirmation of Zika fever diagnosis. ZIKV RNA may be detected in blood serum, saliva, amniotic and cerebrospinal fluids, urine, semen, vaginal and cervical secretions. The duration of viremia in case of Zika fever is short; therefore the presence of ZIKV RNA in urine and sperm for up to 26 and 80 days, respectively, extends the time interval for the detection of this pathogen. Detection of IgM antibodies by serological methods is not a good reason to confirm a recent infection, since antibodies of this class, specific to flaviviruses, circulate in the bloodstream for more than 12 weeks. The IgM show high diagnostic value in confirmation of congenital infection only. There is a problem of differential diagnostics of flavivirus infections caused by antigenically related viruses that are dangerous for humans, for instance, Dengue, Yellow fever, West Nile fever viruses, tick-borne and Japanese encephalitis viruses. It is associated with the similarity of their genomes and, consequently, similar antigenic structure of viral proteins, structural glycoprotein E in particular. More reliable results can be obtained by using the nonstructural glycoprotein NS1, produced by molecular biology methods, as an antigen for the detection of specific antibodies. This viral protein can also be used in serological tests, as a clinical indicator in case of acute Zika fever. Forty five types of candidate vaccines against ZIKV, such as inactivated, live attenuated, recombinant, peptide, recombinant DNA and RNA-based, virus-vector and virus-like particle ones were designed and studied. It was established that their protective efficacy is mediated by induced antibodies, specific to structural glycoprotein E which initiates receptor binding and fusion with the membranes of infected cells. Currently, there is no licensed preparation for treating patients with flaviviral infections. Various drugs are screened, both with known antiviral effect and approved for use in clinical practice, and new compounds that inhibit the penetration of viral particles into host cells (structural glycoprotein E being the target) and virus replication (targets are NS5, NS2B nonstructural proteins).

The paper presents analysis of epidemiological situation on hemorrhagic fever with renal syndrome around the world and in the Russian Federation over the period of 2009–2018. 5855 cases of hemorrhagic fever with renal syndrome were registered in Russia in 2018 (3.99 per one hundred thousand of the population). Downward trend is observed as compared to 2017 (by 29.6 %). Cases of cluster infection were not reported. It is established that the highest level of morbidity, exceeding the average level across Russia 3.9 times, was noted in the Volga Federal District, where 77.5% of the total cases occurred. The territory of the Russian Federation was differentiated by the HFRS incidence rates. The areas with high levels of morbidity included the entities of the Russian Federation with intensive index range between 9.08 and 41.39 per one hundred thousand of the population, among them Republics of Bashkortostan, Mari El, Tatarstan, and Mordovia, Udmurt and Chuvashi Republics, Kirov, Nizhny Novgorod, Penza, Samara, Ulyanovsk, Kostroma, Yaroslavl, and Jewish Autonomous Regions. The forecast for preservation of tense epidemiological situation on HFRS incidence in the territory of the Volga Federal District was substantiated.

The paper presents the analysis of epidemic activity of natural plague foci around the world, including in CIS and the Russian Federation, over the period of 2000–2018. It was established that in 2010–2018, epidemic manifestations took place in natural plague foci where the main carriers are synanthropic (black, multinippled rats) and commercial (marmots, souslik, ground squirrels) species of rodents. Retaining of low epizootic activity of lowland natural plague foci in the territory of the Russian Federation is observed. In 2018, plague epizooties were detected in the territory of the Gorno-Altai high-mountain and Tuva mountain natural foci, the total coverage area being 2641 km2. 13 strains of the main subspecies and 6 strains of Altaic subspecies of plague microbe were isolated. Demonstrated were the prospects of GIS-technology usage for the enhancement of epidemiological surveillance over plague in Russia. Epizootiological forecast for persisting challenging epidemiological situation in Kosh-Agach district of the Republic of Altai and Mongun-Taiginsky, Ovyursky and Tes-Khemsky Kozhuuns of the Republic of Tuva was substantiated. Recorded was high probability of retention of strained epizootic and epidemiological situation in the south and central parts of the desert zone in the Republic of Kazakhstan, high-mountain areas of the Republic of Kyrgyzstan. Also conservation of epidemic risks for the territories of the countries in Africa (Republic of Madagascar), South (Peru, Bolivia), and North (USA) America, China, and Mongolia was noted.

The process of extracting the Echinacea herbs (Echinacea Moench) has been developed with a series of water-alcohol solutions with an alcohol concentration of 70%, 40%, 20%. Extraction was carried out in the vacuum boiling mode with periodic pulsations of the vacuum. Such a regime provided high speed of the process and the possibility of extracting both lipophilic (chlorophyll derivatives, carotenoids) and hydrophilic (chicory acid and its derivatives) BAS. The kinetics of BAS extraction at three stages of maceration was studied: chicory acid is extracted by the polar extractant at all stages of extracting; the lipophilic components pass into the extraction at the stage of treatment with an alcoholconcentration of 70%. Method of micropreparative thin-layer chromatography with eluting and UV-analysis of the eluates was used to determine the groups of extractable BAS. A comparison of dry extracts obtained by water extraction, 24% alcohol extraction and extraction of a number of extractants with sequentially increasing polarity was made. It is established that the method of polyextraction allows to obtain a product containing the widest spectrum of BAS Echinacea.

This review presents the analysis of the literature data on the mechanisms of ZIKV pathogenesis using biomodels (sensitive cell cultures and animals). Human and animal cell cultures have shown that this virus effectively infects primary endometrial stromal cells, embryonic stem cells, cortical and motor neurons, astrocytes, peripheral neurons and neural crest cells of the embryo. Cultures of prostate, testis and kidney cells showed a high level of ZIKV load without cytopathic disorders which implies their participation in the persistence of the pathogen. A productive infection of ZIKV on cell cultures derived from non-human primate, pig, rabbit, hamster and chicken suggests that these animal species may be important reservoirs and/or potential laboratory models. Monkeys of the species Macaca mulatta (macaque rhesus) have the disease caused by ZIKV similar to that in humans. Therefore these animals are a suitable model for studying the pathogenesis of a congenital infection as well as for preclinical evaluation of vaccines and antiviral drugs during pregnancy. Mice, domestic pigs and humanized chicken embryos can be used as surrogate models for studying ZIKV pathogenesis. Recently, attenuated ZIKV has become the object of research in a new area of medical virology – in oncolytic virotherapy against glioblastoma.

The first attempts to create devices that allow interacting with the imitated reality, as well as augmenting reality with superimposed information, were made at the beginning of the 20th century, the very concept of mixed reality (the “reality-virtuality continuum”), which elements are virtual (VR) and augmented (AR) reality, is quite young (24 years), as well as the market of these technologies. The concept of virtual and augmented reality hasn’t changed radically in the past 30 years, but VR and AR devices and software, and content have gone through a significant evolutionary path, and have already experienced several growth spikes.VR and AR technologies can be applied not only in entertainment and games. Many experts believe that virtual and augmented reality, along with Big Data, cloud technologies, artificial intelligence and some others, will become the key technologies of the 4th industrial revolution. VR and AR also have the potential to become the next big computing platform. Today VR and AR technologies help not only to create conceptually new markets, but also to disrupt existing ones.This article discusses the evolution of the VR and AR concepts and technologies and current market trends. The results of the survey show the key obstacles for the mass distribution of AR and VR technologies: high implementation and operational costs of AR/VR solutions; lack of high-quality content and imperfect devices, implicit effectiveness of their use.Based on the empirical study, a rather extensive list of benefits from using virtual and augmented reality technologies has been drawn up: faster and cheaper learning, training and guiding processes, increase in their efficiency, the reduction of the costs of elements and supplies needed, training support personnel; reducing potential risks to life and health of employees and other people while special training (medical operations and invasive procedures, evacuation, security, rescue in various emergencies) and the related optimization of the compensations; reducing the number of errors and accelerating the processes of assembling, repairing and operating special equipment, searching for information, necessary details, product location in the warehouse; significant reduction of accidents rate, as well as the exploration costs, due to the early identification of malfunctions; accelerating the pace of the designing and prototyping objects, significantly reducing the cost and duration of physical modeling process; improving customer experience, product and trading platforms design, that leads to corresponding increase in volume of sales; improving (simplifying) of communication and increasing its effectiveness.

Aim. To study the dynamics of procollagen type I carboxy-terminal propeptide (PICP) with an assessment of potential associations with cardiac fibrosis (CF) and diastolic dysfunction (DD) of the left ventricle (LV) during the hospitalization and one year after ST segment elevation myocardial infarction (STEMI).Material and methods. The study included 120 patients with STEMI. There were following inclusion criteria: diagnosis of STEMI (2015 European Society of Cardiology guidelines); Killip £III acute heart failure (AHF); signed informed consent; patient age >18 years old. There were following exclusion criteria: STEMI due to percutaneous coronary intervention or coronary artery bypass grafting; Killip IV AHF; patient age >80 years; clinically significant comorbidities; death of the patient during the first day of hospitalization. On the 1st, 12th day of the disease and after a year all patients underwent echocardiography and the PICP concentration was determined. One year after myocardial infarction, contrast-enhanced cardiac magnetic resonance imaging was performed to assess CF. In the analyzed group of patients, on day 1 of STEMI, mean values of LV ejection fraction (EF) in the range of 40-49% were observed in 3 (2,5%) patients, LVEF

Aim. To study changes in the level of fibrotic scarring marker — the N-terminal propeptide type III procollagen (PIIINP) and structural and functional parameters with the assessment of diastolic function in patients a year after ST segment elevation myocardial infarction (STEMI) and preserved left ventricle (LV) contractility.Material and methods. At first, the study included 120 (100%) STEMI patients. Next, patients with an LV ejection fraction (EF) ≥50% were selected. The final analysis included 86 STEMI patients. Upon hospitalization, the patients underwent routine diagnostic tests, coronary angiography with stenting of culprit artery. Echocardiography and determination of venous blood PIIINP and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels was on the 1st (time point 1) and 12th day (time point 2) of disease and after a year (time point 3). To compare the obtained values of fibrotic scarring markers, a control group was formed, including 20 (100%) healthy volunteers, identical in age and sex with the studied sample.Results. On the first day of MI, 25 (29,1%) patients with signs of diastolic dysfunction (DD) were identified among those with preserved LVEF. After 1 year, the number of such patients increased by 10% (n=9). Initially increased (relative to the control group) concentration of PIIINP on the first day (311,2 [220,1; 376,3] ng/ml) decreased by the 12th day (223,3 [195,3; 312,1] ng/ml) and returned to the initial values a year after the MI (312,6 [228,0; 383,8] ng/ml). The NT-proBNP concentration during the hospitalization period did not exceed the reference values and did not differ between 1 and 2 time points (p=0,127). One year later, the NT-proBNP concentration significantly exceeded the values of the previous determinations and amounted to 124,4 pg/ml (p=0,043). According to the ROC analysis, with a PIIINP ≥387,8 ng/ml on the first day, the risk of DD increases (p=0,050, sensitivity, 84,62%, specificity, 55,56%) within a year after STEMI with preserved LVEF.Conclusion. The threshold of PIIINP (≥387,8 ng/ml) was established for the first day of MI, at which the risk of DD increases one year after the index event. An increase in NT-proBNP concentration one year after STEMI indicates the progression of heart failure.

Aim. To study the changes of echocardiographic parameters and their relationship with the procollagen I C-terminal propeptide (PICP) during hospitalization of patients with ST-segment elevation myocardial infarction (STEMI) and preserved left ventricular (LV) systolic function.Material and methods. A total of 120 (100%) patients hospitalized with STEMI were examined. Upon admission, all patients underwent standard examinations to verify myocardial infarction (MI), including coronary angiography and, if necessary, coronary stent implantation. The mean values of LV ejection fraction (LVEF) were 40-49% in 3 patients (2,5%),

Assessed has been epidemiological situation on hemorrhagic fever with renal syndrome (HFRS) in the territory of the Russian Federation in 2013–2017. Forecast for 2018 has been substantiated. 39238 HFRS cases in 59 administrative territories of 8 Federal Districts were registered over the analyzed period. The highest morbidity rates were reported in the Privolzhsky Federal District, where 82.9 % of the total case number occurred. Given has been the forecast for the retention of adverse situation on HFRS in 2018 in the territory of Privolzhsky and Central Federal Districts. In order to reduce the HFRS incidence among the population it is necessary to increase the scale and scope of monitoring investigations and strengthen their epidemiological aspect, as well as substantiate, plan and carry out broad range of measures of non-specific prophylaxis.

The prevalence of the excessive weight and obesity increasing in the human population is a significant concern to the public health. The article provides a literature review devoted to pathophysiologic aspects of the obesity and vitamin D deficiency interconnection. A role of adipokines (leptin, adiponectin), cells of the immune system, proinflammatory cytokines in the pathogenesis of obesity and place of vitamin D as an endocrine and paracrine regulator of inflammatory processes in the fatty tissue. An important role of the vitamin D deficiency in the genesis of the insulin resistance is shown that underlies the fatty tissue accumulation and formation of the metabolic profile characteristic of obesity. Direct and indirect vitamin D effect on the insulin synthesis in the pancreatic gland and sensitivity to it of insulin receptors in the body tissues is demonstrated.