Background Remission is the primary objective of treating juvenile idiopathic arthritis (JIA). It is still debatable whether early intensive treatment is superior in terms of earlier achievement of remission. The aim of this study was to evaluate the effectiveness of early etanercept+methotrexate (ETA+MTX) combination therapy versus step-up MTX monotherapy with ETA added in refractory disease. Methods A multi-centre, double-blind, randomized study in active polyarticular JIA patients treated with either ETA+MTX (n = 35) or placebo+MTX (n = 33) for up to 24 weeks, followed by a 24-week open-label phase. The efficacy endpoints included pedACR30 criteria improvement at week 12, inactive disease at week 24, and remission at week 48. Patients who failed to achieve the endpoints at week 12 or at week 24 escaped to open-label ETA+MTX. Safety was assessed at each visit. Results By intention-to-treat analysis, more patients in the ETA+MTX group reached the pedACR30 response at week 12 (33 (94.3%)) than in the placebo+MTX group (20 (60.6%); p = 0.001). At week 24, comparable percentages of patients reached inactive disease (11 (31.4%) vs 11 (33.3%)). At week 48, 11 (31.4%) and eight (24.2%) patients achieved remission. The median (+/−IQR) times to achieve an inactive disease state in the ETA+MTX and placebo+MTX groups were 24 (14–32) and 32 (24–40) weeks, respectively. Forty-four (74/100 patient-years) adverse events (AEs) were reported, leading to treatment discontinuation in 6 patients. Conclusions Early combination therapy with ETA+MTX proved to be highly effective compared to the standard step-up regimen. Compared to those treated with the standard regimen, more patients treated with a combination of ETA+MTX reached the pedACR30 response and achieved inactive disease and remission more rapidly.

Aim. To assess echocardiography data of the main structural myocardial changes in children with WPW-syndrome. Material and methods. The study included 26 children with WPW-syndrome without organic cardiac pathology and 24 healthy children (comparative group). All children underwent electrocardiography, Holter-ECG, echocardiographic examination according to R. Devereux (1982) and B. Marón (2005) criteria with calculation of Z-factors for the main cardiac anatomical structures and myocardial mass index by Pettersen M.D technique (2008) in A.S. Sharykin modification (2013) to detect myocardial remodeling. The research was conducted at specialized cardiologic department within 3 years. Results. Morphological and functional myocardial changes were revealed in both groups. There were significant changes of left ventricular end-systolic dimension, systolic LV posterior wall thickness (PWT), diastolic interventricular septum thickness, systolic interventricular septum thickness, left atrial dimension, LV ejection fraction. So, arrhythmogenic myocardial dysfunction in children with WPW-syndrome including hemodynamic changes and impaired contractility is present. Conclusion. Significant changes of morpho-functional parameters of the heart confirm arrhythmogenic myocardial dysfunction in children with WPW-syndrome.

Background Remission is the primary objective of treating juvenile idiopathic arthritis (JIA). It is still debatable whether early intensive treatment is superior in terms of earlier achievement of remission. The aim of this study was to evaluate the effectiveness of early etanercept+methotrexate (ETA+MTX) combination therapy versus step-up MTX monotherapy with ETA added in refractory disease. Methods A multi-centre, double-blind, randomized study in active polyarticular JIA patients treated with either ETA+MTX (n=35) or placebo+MTX (n=33) for up to 24 weeks, followed by a 24-week open-label phase. The efficacy endpoints included pedACR30 criteria improvement at week 12, inactive disease at week 24, and remission at week 48. Patients who failed to achieve the endpoints at week 12 or at week 24 escaped to open-label ETA+MTX. Safety was assessed at each visit. Results By intention-to-treat analysis, more patients in the ETA+MTX group reached the pedACR30 response at week 12 (33 (94.3%)) than in the placebo+MTX group (20 (60.6%); p=0.001). At week 24, comparable percentages of patients reached inactive disease (11 (31.4%) vs 11 (33.3%)). At week 48, 11 (31.4%) and eight (24.2%) patients achieved remission. The median (+/-IQR) times to achieve an inactive disease state in the ETA+MTX and placebo+MTX groups were 24 (14–32) and 32 (24–40) weeks, respectively. Forty-four (74/100 patient-years) adverse events (AEs) were reported, leading to treatment discontinuation in 6 patients.Conclusions Early combination therapy with ETA+MTX proved to be highly effective compared to the standard step-up regimen. Compared to those treated with the standard regimen, more patients treated with a combination of ETA+MTX reached the pedACR30 response and achieved inactive disease and remission more rapidly.Trial registrationThe study was registered by the European Clinical Trials Database (EudraCT) as 2015-003384-11 on 07-21-2014.

Резюме Цель: оценить состояние неспецифического иммунитета у женщин с рецидивирующим течением герпетической инфекции, планирующих беременность, в период гестации, у новорожденных и детей первого полугодия жизни в зависимости от метода профилактики рецидивов инфекции и внутриутробного инфицирования. Материалы и методы: под динамическим наблюдением находились 342 беременные женщины с рецидивирующим течением герпетической инфекции и их дети. Обследование на наличие герпетической инфекции проводилось с применением методов ПЦР и ИФА. У женщин и их детей исследовались: интерфероновый статус, показатели фенотипирования лимфоцитов, уровни фактора некроза опухоли, фактора роста плаценты, плацентарной щелочной фосфатазы, плацентарного альфа-1 микроглобулина, интерлейкина 10, иммуноглобулинов классов A, M, G; для оценки состояния фетоплацентарного комплекса использовались ультразвуковые методы. Состояние здоровья новорожденных и детей первого полугодия жизни оценивалось с учетом диагностики внутриутробного инфицирования вирусом простого герпеса и реализации соматической патологии. Результаты: обоснован метод профилактики внутриутробного инфицирования плода с применением препарата Аллоферон на догестационном этапе и человеческого рекомбинантного интерферона альфа-2b в антенатальном периоде. Доказана ассоциативная связь между эффективностью этапной превентивной терапии и частотой осложнений гестации, внутриутробного инфицирования вирусом простого герпеса, состоянием неспецифического иммунитета у беременных, новорожденных и детей первого полугодия жизни. Заключение: рецидивирующее течение герпетической инфекции во время беременности, дисбаланс в системе неспецифического иммунитета, развитие плацентарной недостаточности приводят к напряжению противоинфекционного иммунитета в период новорожденности как у детей с внутриутробным инфицированием, так и у неинфицированных детей. У новорожденных детей с реализацией герпетической инфекции наблюдается угнетение неспецифического иммуните-ВЛИЯНИЕ мЕТОдА пРОФИЛАКТИКИ ВНУТРИУТРОБНОгО ИНФИЦИРОВАНИЯ НА СОСТОЯНИЕ НЕСпЕЦИФИЧЕСКОгО ИммУНИТЕТА У БЕРЕмЕННЫХ С РЕЦИдИВИРУющИм ТЕЧЕНИЕм гЕРпЕТИЧЕСКОй ИНФЕКЦИИ И ИХ дЕТЕй М.А. Овчинникова, И.С. Липатов, Г.В. Санталова, Ю.В. Тезиков Самарский государственный медицинский университет, Самара, Россия the impact of the method of prevention of intrauterine infection on the state of nonspecific immunity in pregnant women with relapsing herpetic infection and their children Abstract Purpose of the study: to assess the state of nonspecific immunity in women with relapsing herpetic infection, planning pregnancy, period of gestation, from infants and children in the first six months of life, depending on the method of prophylaxis of relapses of infection and intrauterine infection. Оригинальное исследование ЖУРНАЛ ИНФЕКТОЛОГИИ Том 10, № 1, 2018 71 Key words: recurrent herpes infection, innate immunity, pregnancy, intrauterine infection, Alloferon, human recombinant interferon alfa-2b.

Objective:to study the features of the clinical and epidemiological characteristics of whooping cough in children in the Samara region.Materials and methods: 389 cases of pertussis in the Samara region for 2015–2016 were analyzed.Results: it is shown that in spite of 95–98% vaccination coverage, in recent years there has been an increase in the incidence of whooping cough. Seasonality of morbidity remains. Among the children observed, the youngest children were not vaccinated against pertussis. The clinical picture of the disease remains typical with the classic course of catarrhal and spasmodic periods. Moderately severe forms of the disease predominate. Complications were noted mainly in unvaccinated children of the first year of life. The most frequent complications were pneumonia and apnea. There is a hypodiagnosis of pertussis in outpatient conditions. Infection often occurs under the mask of ARVI, while the sensitivity of the bacteriological method of diagnosis is zero. Of the methods for confirming the diagnosis, the most reliable is ELISA and PCR.Conclusion: these epidemiological and clinical features of pertussis current testify to the need to further improve methods of early diagnosis, especially express methods, etiopathagenetic treatment, specific prevention, antiepidemic measures in the foci of infection.