Regional Aspects of Nosocomial Infection As a Medical and Social Problem

Prevention of nosocomial infection (NI) is an important medical and socioeconomic problem. And though certain organizational and practical measures are implemented in Russia every year to reduce NIs, the problem is still relevant from medical and social points of view. The risk of infection are both for patients and medical workers. In Russia, the minimum economic damage caused by NIs is 2.5–5 billion rubles annually. According to the Office of the Federal Service for Supervision of Consumer Rights Protection and Human Welfare in the Republic of Mordovia, the total incidence of NI in the region is at a low level. The incidence rate was 0.01 per 1000 patients in hospitals. The dynamics of the last five years demonstrates a decrease in hospital-acquired infections. In the dynamics of the last five years, incidence rates of purulent-septic infections of newborns and postpartum women, postoperative purulent-septic complications and post-injection complications had an unstable downward trend. Thus, purulent-septic infections of newborns and postpartum women and postoperative infections are dominated in the structure of nosocomial infections. Analysis of dynamics of morbidity in recent years in the Republic of Mordovia suggests that the measures taken to prevent NI are quite effective and are manifested with consistently low rates

Electrophysiological Parameters of Sinus Node Function in Patients with Paroxysmal Tachyarrhythmias

to analyze the indicators of the function of the sinus node in patients of young age with paroxysmal tachycardia. Methods: study included 11 patients with suspected paroxysmal tachycardia, with an average age of 17±28. The basis for holding transesophageal electrophysiological study (TE EPS) was the clinical and electrophysiological characteristics of paroxysmal tachycardia. According to the results of Holter monitoring ECG (HM ECG) analyzed the minimum and maximum heart rate, number of ventricular and supraventricular arrhythmias, presence of pauses, rhythm and episodes of paroxysmal tachycardia. According to CHP, EFI estimated the initial heart rate (HR), recovery time of sinus node function (RTSNF), corrected recovery time of sinus node function (CRTSNF), point of Wenkebach (p. W), duration of the effective refractory period of the atrioventricular connections, presence of aberrant complexes and episodes of paroxysmal tachycardias before and after administration of atropine at a dose of 0.02 mg/kg. Results: Complaints characteristic of the tachyarrhythmia was diagnosed in 9 patients, episodes of heart rate more than 150 beats per minute in 7 patients. When conducting TE EPS obtained the following results: episodes of supraventricular tachycardia provoked in 8 patients (in two cases of paroxysmal tachycardia managed to provoke only after administration of atropine). Three of them have shimmer and atrial flutter episodes reciprocal tachycardia in five. Three patients provoke paroxysmal tachycardia failed, but they showed a shortening of the PQ interval and the appearance of aberrant QRS complexes when stimulated. In patients with paroxysmal SVT signs of sinus node dysfunction was detected in 6 patients, in the form of episodes of sinus arrhythmia (4 patients), migration pacemaker the atria (4 patients), sinoatrial blockade of II degree (3 patients), blockade of legs of bunch of gisa (2 patients), atrioventricular block degree II-III (1 patient), RTSNF more than 1500 MS in 1 patient, CRTSNF greater than 500 msec in 3 patients. Conclusion: in 6 of 9 patients with supraventricular paroxysmal tachycardia revealed signs of sinus node dysfunction, probably has a vagotonic in nature

Phylogenetic Analysis of Yersinia pestis Strains of Medieval Biovar, Isolated in Precaspian North-Western Steppe Plague Focus in the XX Century

Objective of the study – comparative phylogenetic analysis of Yersinia pestis strains, isolated in Precaspian North-Western steppe focus in 1924–1926, 1972, and 1986–1990 to understand the causes of focal reactivation during different time periods of the XX century.Materials and methods. The work included 30 strains of Yersinia pestis from Precaspian North-Western steppe natural focus and adjacent plague foci. Whole genome sequencing of eight Y. pestis strains from the former was carried out. Also whole-genome sequences of 16 strains from neighboring natural foci were used. Whole-genome sequencing of Y. pestis strains was conducted in Ion PGM system (Life technologies). SNPs search across the core genome was performed using software package Wombac 2.0. Tree diagram Maximum Likelihood, HKU85 model, was constructed to analyze phylogenetic relations.Results and discussion. It is established that in early XX century (1924–1926), strains of phylogenetic branches 2.MED4 and 2.MED1, belonging to medieval biovar, main subspecies, circulated on Ergenin Upland in the Precaspian North-Western steppe natural focus. Later on they became extinct in the territory. It is shown that the strains, isolated on Ergenin Upland in 1972, constituted a common subcluster on the dendrogram with the strains from low-mountain and piedmont plague foci of Caucasus and Transcaucasia, dated the same time period. It was inferred that epizootic manifestations on Ergenin upland in 1972, after a long recess since 1938, were caused by importation of Y. pestis strains from low-mountain natural plague foci of Caucasus and Transcaucasia. It was noted that expansion of Caucasian strains was of short-term character, and plague infected animals have not been found on Ergenin Upland since 1974 (including modern period). It is established that Y. pestis strains isolated in the eastern part of Precaspian North-Western steppe focus between 1986 and 1990, do not have close genetic relation to the strains that circulated on Ergenin Upland in 1924–1926 and 1972. It is determined that each epizootic period (1913–1938 and 1972–1973) in Precaspian North-Western steppe natural focus culminated in the elimination of the circulating Y. pestis strains and rehabilitation of the focal territory

Tracing the Spatial Circulation of Yersinia pestis of Medieval Biovar in the Eastern Caspian Sea Region in the 20th Century Based on Genome-Wide SNP Analysis

A comprehensive analysis of the accumulated epidemiological and epizootiological data in combination with results from phylogenetic analysis of Yersinia pestis strains creates the basis for establishing patterns of spatialtemporal distribution of the plague pathogen and opens up the prospect of long-term forecasting of natural plague foci activation. Previously, we traced the distribution pathways of Y. pestis, medieval biovar, in the plague foci of the Northern and Northwestern Caspian Sea regions in the 20th and early 21st centuries.The purpose of this work was to identify the regularities of circulation of Y. pestis, medieval biovar, in four natural plague foci located in the Eastern Caspian Sea region.Materials and methods. A complex study of the phenotypic and genetic properties of 16 Y. pestis strains isolated in the Ustyurt, Mangyshlak, Karakum and Kopetdag autonomous desert plague foci in 1926–1985 was carried out. They were compared with strains from other natural plague foci in Eastern Europe and Central Asia obtained in 1917–2003. Whole-genome sequencing of 12 of those strains was performed. Phylogenetic analysis included the genomes of other 19 Y. pestis strains that we had sequenced earlier. Based on the 1717 polymorphic nucleotides (SNPs) identified in the core genome, a dendrogram of the relations of the studied strains was constructed.Results and discussion. All 16 Y. pestis strains from the Ustyurt, Mangyshlak, Kopetdag, and Karakum desert foci belong to the 2.MED1 branch of the medieval biovar. All investigated strains from the first three foci and most of the strains from the Karakum focus are in the Caspian 2.MED1 branch, and three strains from the Karakum desert focus are included in the Central Asian one. We have revealed several waves of dissemination of the strains under the 2.MED1 phylogenetic branch of Y. pestis of the medieval biovar in the Eastern Caspian Sea region in the 20th century

Dissemination of <i>Yersinia pestis</i> of Medieval Biovar in Northern, North-Western Caspian Sea Region and Fore-Caucasus in the second Half of the Twentieth Century

Objective of the study was to determine the origin of Y. pestis strains that widely disseminated in natural plague foci of Northern, North-Western Caspian Sea region and Fore-Caucasus in the second half of the XX century. Materials and methods. We have carried out the investigation of properties and whole genome sequencing of 22 Y. pestis strains, isolated between 1923 and 2003 in five natural foci of the souslik type, situated in Northern and North-Western Caspian Sea region and Fore-Caucasus. Phylogenetic analysis was conducted using the data of whole genome SNP-typing, based on 1348 identified SNPs. The search of SNPs in the core genome was performed with the help of Wombac 2.0 software. Phylogenetic relations were analyzed using Maximum Likelihood dendrogram, GTR model. Results and discussion. All the studied strains from the foci of Northern, North-Western Caspian Sea region and Fore-Caucasus fall into phylogenetic branch 2. MED1of medieval biovar. On the basis of whole genome SNP-analysis, existence of two groups of closely related strains, comprising the strains dated 1923-1945 and 1962-2003, has been revealed. The predecessors of the 1962-2003 strains from the Northern, North-Western Caspian Sea region and Fore-Caucasus on the phylogenetic tree are the strains from Northern Aral Sea region that go back to 1945. It testifies to the fact that synchronized activation of a group of natural foci in Caspian Sea lowland and Fore-Caucasus in 1975-1979, after prolonged 20-37 year long breaks, could be caused by the dissemination of the strains from the Northern Aral Sea region. The data of epizootic observations indicate that activation of Volga-Ural sandy plague focus in 1960s preceded the start of registration of plague epizooties in the territory of natural foci of souslik type in Northern, North-Western Caspian sea region and Fore-Caucasus

SNP-Profiles of <i>Yersinia pestis</i> Strains of the Medieval Biovar from the Caspian Sea Region Plague Foci

The SNP-typing method based on the detection of stable genetic markers in the genome, i.e., single nucleotide polymorphisms, is successfully used for genotyping of pathogenic microorganisms and can be applied for SNP-profiling of Yersinia pestis strains and molecular-genetic certification of focal areas. The aim of the study was to determine the SNP profiles of Y. pestis strains of the medieval biovar isolated in the Caspian Sea region plague foci in 1912–2015 and to develop a method for identifying unique SNPs using the Sanger sequencing for molecular-genetic certification of these territories. Materials and methods. A comprehensive study of the phenotypic and genotypic properties of 190 Y. pestis strains from plague foci in the Caspian Sea region was carried out. Phylogenetic reconstruction by the Maximum Likelihood method (GTR model) in the SeaView 5.0.4 software was performed on the basis of 1621 SNPs identified among 50 Y. pestis strains according to WG-SNP analysis in the snippy 4.6 program. Primers for PCR amplification of the SNP loci selected as target were calculated using the Vector NTI program. Sanger sequencing of SNPs loci was conducted on an ABI PRISM 3500XL genetic analyzer (Applied Biosystems, USA). Results and discussion. According to phenotypic characteristics, all studied strains from the Caspian foci belonged to a highly virulent and epidemically significant medieval biovar of the main subspecies of Y. pestis. According to the results of the WG-SNP analysis, 9 SNP genotypes were identified based on the polymorphism of single nucleotides of 24 genes characteristic of the main phylopopulations, which include strains isolated during various periods of epidemic and epizootic activity in the Caspian plague foci. Determining of SNP genotypes of Y. pestis strains of the medieval biovar, obtained over a hundred years in the Caspian foci, creates the prerequisites for defining the canonical SNP profile (canSNP) and for developing an algorithm for molecular epidemiological monitoring of the foci in which this highly virulent biovar circulates

Development of an Integrated System for Molecular-Genetic Identification of <i>Yersinia pestis</i> Strains

The paper describes a developed comprehensive system for molecular-genetic identification of Yersinia pestis strains according to their appurtenance to certain subspecies, biovars, phylo-geographic populations, using realtime PCR (RT-PCR), allele-specific RT-PCR, and multiplex PCR with hybridization fluorescent registration of results on a solid substrate. Application of this system makes it possible to establish the appurtenance of Y. pestis strains to the following phylogenetic branches: 0.ANT1, 0.ANT2, 0.ANT3, 0.ANT5, 3.ANT, 4.ANT of antique biovar of the main subspecies; 2.MED0, 2.MED1, 2.MED2, 2.MED3, 2.MED4 of medieval biovar of the main subspecies; 1.IN1, 1.IN2, 1.IN3 of intermedium biovar of the main subspecies; 1.ORI1, 1.ORI2, 1.ORI3 of oriental biovar of the main subspecies; 0.PE3 (angolica subspecies), 0.PE7 (tibetica subspecies) and 0.PE10 (qinghaica subspecies). The first stage of the studies within the frames of the developed system is indication of plague agent using registered diagnostic drugs. The second stage is the determination of belonging to individual subspecies through RT-PCR or by the method of multiplex PCR system with hybridization-fluorescent registration of results on a solid substrate, which also allows for establishing to which biovars of the main subspecies and the main phylogenetic lines of the ancient biovar the strains belong. The third stage is the identification of strain appurtenance to phylogenetic branches by the AS-RT-PCR method. The designed complex system for molecular-genetic identification of Y. pestis strains can be applied at the regional and federal levels of the laboratory network of the Russian Federation for diagnostics of infectious diseases. Its use will considerably facilitate and increase the efficiency of intraspecific differentiation of Y. pestis strains within the framework of the epidemiological investigation of outbreaks or importation of strains of plague pathogen into the territory of the Russian Federation or during the certification of strains in collection activities

Фено- и генотипический портрет штаммов Yersinia pestis филогрупп 2.MED4 и 2.MED1 – этиологических агентов вспышек чумы ХХ века в Прикаспийском регионе

We performed a comparative analysis of the phenotypic and genotypic characteristics of strains of the plague pathogen of phylogroups 2.MED4 and 2.MED1 of the medieval biovar of the main subspecies from epidemically active plague foci in the Caspian Sea region in the XX century. According to the results of the analysis, biochemical properties, nutritional requirements and plasmid profile of strains of phylogroups 2.MED4 and 2.MED1 of the medieval biovar of Y. pestis were determined. Genetic variability in the hemS, caf1M, and ssaJ genes associated with the virulence in strains of the 2.MED lineage was revealed. The data obtained on the phenotypic and genotypic characteristics of the medieval biovar of the plague microbe can be used in laboratory diagnostics of the plague microbe and will contribute to the study of genome changing in the process of microevolution of this highly virulent biovar.Проведен сравнительный анализ фенотипических и генотипических характеристик штаммов возбудителя чумы филогрупп 2.MED4 и 2.MED1 средневекового биовара основного подвида из эпидемически активных в ХХ веке очагов чумы Прикаспийского региона. По результатам анализа определены биохимические свойства, питательные потребности и плазмидный профиль штаммов филогрупп 2.MED4 и 2.MED1 средневекового биовара Y. pestis. Выявлена генетическая вариабельность в генах hemS, caf1М и ssaJ, ассоциированных с вирулентностью, у штаммов линии 2.MED. Полученные данные по фенотипическим и генотипическим характеристикам средневекового биовара могут найти свое применение в лабораторной диагностике чумного микроба и внесут вклад в исследование преобразований генома в процессе микроэволюции этого высоковирулентного биовара

ОЦЕНКА ТЯЖЕСТИ БОЛЕЗНИ И ПОДБОРАДЕКВАТНОЙ ДОЗЫ БАЗИСНОЙ ТЕРАПИИМЕТОТРЕКСАТОМ У РЕБЕНКА С ЮВЕНИЛЬНЫМ ПОЛИАРТРИТОМ

The article presents a short review of the current notion of the leading role methotrexate in treatment of most clinical variants ofjuvenile idiopathic arthritis. The authors demonstrate that methotrexate is a “gold standard” of antirheumatic therapy and the key disease-modifying drug of pediatric rheumatology. The emphasis is laid on safety profile and advantages of parenteral administration thereof. The article presents follow-up of a clinical case involving use of dosage form of methotrexate in the dose of 15 mg/m per week for subcutaneous administration in a patient with polyarticular juvenile idiopathic arthritis featuring insufficient effectiveness and low tolerance of the oral drug. Prescription of methotrexate for subcutaneous administration helped to terminate progression of the disease and pain syndrome and improve function of the affected joints and the patient’s quality of life. В статье дан краткий обзор современных представлений о ведущем месте метотрексата в лечении большинства клинических вариантов ювенильного идиопатического артрита. Показано, что метотрексат ― «золотой стандарт» противоревматической терапии, ключевой болезньмодифицирующий препарат в педиатрической ревматологии. Сделан акцент на профиль его безопасности и преимущества парентерального способа введения. В статье представлено наблюдение клинического случая использования дозированной формы метотрексата в дозе 15 мг/м2 в нед для подкожного введения у пациента с полиартикулярным вариантом ювенильного идиопатического артрита с недостаточной эффективностью и плохой переносимостью перорального препарата. Назначение метотрексата для подкожного введения позволило остановить прогрессирование заболевания, купировать болевой синдром, улучшить функцию пораженных суставов и повысить качество жизни пациента.

Comparative study of cytotoxicity of ferromagnetic nanoparticles and magnetitecontaining polyelectrolyte microcapsules

The work was supported by Ministry of Education and Science of the Russian Federation as part of the State task for National Research Mordovia State University, project No. 2952 and the Government of the Russian Federation (grant №14.Z50.31.0004 to support scientific research projects implemented under the supervision of leading scientists