Organization of microbiologic monitoring in epidemiologic surveillance of community-acquired pneumonia

The article deals with the results of the microbiological monitoring during the observation of the patients with community-acquired pneumonia, who have been admitted to a hospital therapeutic department. The quantitative criteria for assessing the etiological significance of microorganisms isolated from sputum have been proposed. The microbial landscape in the presence of community-acquired pneumonia have been studied, the prevalence of the fungi of the genera Candida, Streptococcus spp. and Staphylococcus spp have been found. The differences in the etiological structure of pneumonia caused by monocultures and the microbial associations have been identified. The microbial associations including 2 to 4 microorganisms have been examined. While evaluating the susceptibility of pathogens to antibiotics a high proportion of multi-drug resistant strains has been established. The fact that the microbial associations demonstrate a higher prevalence of antibiotic resistance compared to monocultures has been proved. So, it has been established that the microbial associations manifest a greater stability and a higher resistance to the disinfectants compared to the single-associant microbes that form these associations. We have proved the efficacy of the microbiological monitoring organized along with the observation of patients according to the developed parameters. The ways of improving the microbiological monitoring system for epidemiological surveillance of communityacquired pneumonia have been suggested

ПРОБЛЕМНЫЕ ВОПРОСЫ СОЧЕТАННОСТИ КИШЕЧНЫХ ИНФЕКЦИЙ

The  article  presents the  possible combinations of intestinal   infections of  various   etiologies, some   pathogenetic, clinical  and  epidemiological features and  problems of epidemiological surveillance and  control  of  associated infections.  Details  the  combination of typhoid fever,  shigelloses, salmonelloses, yersiniosis, pseudotuberculosis, rotavirus and norovirus infections between itself  and  other  infectious and parasitic diseases. Discusses the clinical  and  epidemiological features different combinations of intestinal infections. It is shown  that  the proportion of combined intestinal infections  can reach  to 48.9±3.3% in the structure of all associated  infections. The proportion of combination of two intestinal  infections pathogens was  29,2±6,5%, 3 agents and 10,3±4,3% and  4 pathogens and  5,9±11,6 percent. In the overall structure of the combination of intestinal anthroponoses with anthroponoses was 61,9±5,3%, anthroponoses with zoonoses was 31,1±5,0%, the other combinations (zoonoses and  zoonoses, zoonoses and  sapronoses, antroponoses with zoonoses and  sapronoses) of  7,0±9,3  percent. The  article raises  the  question of  the  need to  introduce into  existing regulatory framework the  new  scientific data  on the  whole range of features of the epidemiology of intestinal infections combined.В статье представлены возможные  сочетания кишечных инфекций различной этиологии, некоторые патогенетические, клинико-эпидемиологические особенности, а также проблемы эпидемиологического надзора  и контроля за сочетанным инфекциями. Подробно представлены сочетания брюшного тифа,   шигеллеза, сальмонеллеза, иерсиниоза,  псевдотуберкулеза,  ротавирусной и норовирусной инфекций между собой  и другими инфекционными и паразитарными заболеваниями. Рассматриваются клинико-эпидемиологические особенности различных сочетаний кишечных инфекций. Показано, что удельный вес сочетанных кишечных инфекций может  достигать 48,9±3,3%  в  структуре всех  сочетанных инфекций. Удельный вес  сочетания 2 возбудителей кишечных инфекций составил 29,2±6,5%,  3 возбудителей – 10,3±4,3%, 4 возбудителей – 5,9±11,6%. В общей  структуре сочетания кишечных антропонозов с  другими антропонозами составили 61,9±5,3%,  антропонозов с зоонозами – 31,1±5,0%, другие сочетания (зооноз и зооноз, зооноз и сапроноз, антропоноз с зоонозом  и сапронозом) – 7,0±9,3%. В статье поднимается вопрос о необходимости внедрять в существующую нормативно-правовую базу  новые научные данные по всему  спектру особенностей эпидемиологии сочетанных кишечных инфекций

Clinical features of post-COVID-19 period. Results of the international register “Dynamic analysis of comorbidities in SARS-CoV-2 survivors (AKTIV SARS-CoV-2)”. Data from 6-month follow-up

Aim. To study the clinical course specifics of coronavirus disease 2019 (COVID-19) and comorbid conditions in COVID-19 survivors 3, 6, 12 months after recovery in the Eurasian region according to the AKTIV register. Material and methods.The AKTIV register was created at the initiative of the Eurasian Association of Therapists. The AKTIV register is divided into 2 parts: AKTIV 1 and AKTIV 2. The AKTIV 1 register currently includes 6300 patients, while in AKTIV 2 — 2770. Patients diagnosed with COVID-19 receiving in- and outpatient treatment have been anonymously included on the registry. The following 7 countries participated in the register: Russian Federation, Republic of Armenia, Republic of Belarus, Republic of Kazakhstan, Kyrgyz Republic, Republic of Moldova, Republic of Uzbekistan. This closed multicenter register with two nonoverlapping branches (in- and outpatient branch) provides 6 visits: 3 in-person visits during the acute period and 3 telephone calls after 3, 6, 12 months. Subject recruitment lasted from June 29, 2020 to October 29, 2020. Register will end on October 29, 2022. A total of 9 fragmentary analyzes of the registry data are planned. This fragment of the study presents the results of the post-hospitalization period in COVID-19 survivors after 3 and 6 months. Results. According to the AKTIV register, patients after COVID-19 are characterized by long-term persistent symptoms and frequent seeking for unscheduled medical care, including rehospitalizations. The most common causes of unplanned medical care are uncontrolled hypertension (HTN) and chronic coronary artery disease (CAD) and/or decompensated type 2 diabetes (T2D). During 3- and 6-month follow-up after hospitalization, 5,6% and 6,4% of patients were diagnosed with other diseases, which were more often presented by HTN, T2D, and CAD. The mortality rate of patients in the post-hospitalization period was 1,9% in the first 3 months and 0,2% for 4-6 months. The highest mortality rate was observed in the first 3 months in the group of patients with class II-IV heart failure, as well as in patients with cardiovascular diseases and cancer. In the pattern of death causes in the post-hospitalization period, following cardiovascular causes prevailed (31,8%): acute coronary syndrome, stroke, acute heart failure. Conclusion. According to the AKTIV register, the health status of patients after COVID-19 in a serious challenge for healthcare system, which requires planning adequate health system capacity to provide care to patients with COVID-19 in both acute and post-hospitalization period

PROBLEMATIC ISSUES OF COMBINED INTESTINAL INFECTIONS

The  article  presents the  possible combinations of intestinal   infections of  various   etiologies, some   pathogenetic, clinical  and  epidemiological features and  problems of epidemiological surveillance and  control  of  associated infections.  Details  the  combination of typhoid fever,  shigelloses, salmonelloses, yersiniosis, pseudotuberculosis, rotavirus and norovirus infections between itself  and  other  infectious and parasitic diseases. Discusses the clinical  and  epidemiological features different combinations of intestinal infections. It is shown  that  the proportion of combined intestinal infections  can reach  to 48.9±3.3% in the structure of all associated  infections. The proportion of combination of two intestinal  infections pathogens was  29,2±6,5%, 3 agents and 10,3±4,3% and  4 pathogens and  5,9±11,6 percent. In the overall structure of the combination of intestinal anthroponoses with anthroponoses was 61,9±5,3%, anthroponoses with zoonoses was 31,1±5,0%, the other combinations (zoonoses and  zoonoses, zoonoses and  sapronoses, antroponoses with zoonoses and  sapronoses) of  7,0±9,3  percent. The  article raises  the  question of  the  need to  introduce into  existing regulatory framework the  new  scientific data  on the  whole range of features of the epidemiology of intestinal infections combined

The interaction of folate cycle enzyme genes and the risk of extrapyramidal side effects of antipsychotics

Personalized medicine means the selection of therapy for patients, taking into account the assessment of genetic risk factors for side effects. A number of studies show that folate metabolism disorders, including single nucleotide polymorphisms (SNPs) in the genes of folate-metabolizing enzymes, are more frequently detected in schizophrenic patients than in the general population. The role of SNPs of the key folate cycle enzymes in developing the extrapyramidal side effects of antipsychotics has not yet been studied, although there is evidence of their association with other movement disorders.Objective: to analyze the association between the carriage of SNP alleles of MTHFR 677C>T, MTR 2756A>G, and MTRR 66A>G and the severity of extrapyramidal side effects of antipsychotics in patients with schizophrenia.Patients and methods. The investigation included 61 patients with schizophrenia (according to the criteria for ICD-10 Code F20). All the patients took antipsychotics for at least 7 hospital days were examined using real-time polymerase chain reaction (PCR) with allele-specific primers, followed by detection for the carriage of SNP alleles of MTHFR 677C>T, MTR 2756A>G, and MTRR 66A>G. The standardized Simpson–Angus scale (SAS) was used to evaluate the severity of extrapyramidal symptoms; the PCR test results were unknown during their examination.Results and discussion. In the patients carrying a low-functional 677 T allele in the gene of the key folate cycle enzyme MTHFR, the severity of extrapyramidal side effects of antipsychotics was statistically significantly higher than in the carriers of the wild-type genotype: 13.27±5.10 versus 9.84±6.03 SAS scores, respectively (t=-2.40; p=0.020). In addition, the carriage of the wild allele A of SNP in the MTRR 66A>G gene (F=3.83; p=0.0283; pcorr.=0.043) is associated with the severity of extrapyramidal symptoms. There was a direct moderate correlation of the number of risk alleles at two loci with the total SAS score (r=0.51; p=0.00017).Conclusion. The polymorphic allele of MTHFR 677T and the wild allele of MTRR 66A can be regarded as risk alleles for the development of extrapyramidal side effects of antipsychotics

VIRAL ETIOLOGY ACUTE INTESTINAL INFECTIONS MOLECULAR MONITORING IN CHILDREN’S HOSPITAL

On the territory of the Russian Federation in the overall structure of acute intestinal infections the proportion of viral diarrhea among children varies from 24 to 78% of cases depending on the season. The acute viral intestinal infections etiological confirmation is performed mainly among patients of infectious hospitals. The prevalence of viral acute intestinal infections in non-infectious hospitals, including infections associated with medical care, remains unclear. Currently estimation of viral component in the acute intestinal infections overall structure mainly consists in determination of rotavirus infection prevalence excluding other pathogens. As the part of viral etiology hospital infections epidemiological surveillance in non-infections children’s hospital the study of acute viral intestinal infections etiological structure and molecular genetics characterization of identified enteric viruses is conducted. The syndrome diagnosis of acute intestinal infections cases was introduced — an identification and evaluation of patients with signs of dysfunction of the gastrointestinal tract, that is not related to the underlying disease. A set of laboratory methods included identification of various intestinal pathogens DNA (RNA) by PCR-RT method; genotyping of enteric viruses using sequencing; nucleotide sequence analysis of cDNA fragments using the BLAST software package for identification of closely related strains and an online service for automatic genotyping of noroviruses by Norovirus Genotyping Tool Version 1.0. Alignment of nucleotide sequences and phylogenetic analysis was performed using the software MEGA 5.0. The obtained sequence fragments of the genome was downloaded in GenBank international database. The use of molecular genetics research methods allowed to differentiate viral pathogens of acute intestinal infections and to establish the fact of nosocomial transmission. The proportion of viral etiology acute intestinal infections in patients with clinical signs of intestinal infection, and contact persons was 43.8%. The etiological structure of intestinal virus infections was presented by noroviruses (73.2%) genotypes GII.1, GII.3, GII.4 Sydney 2012, rotaviruses (23.2%) genotypes G4P[8] and G1-IP[8], and adenovirus (1.8%) of the group F and astroviruses (1.8%) genotypes 1 and 2. Among the hospitalized children were 9 cases of viral etiology acute intestinal infections importation, and 66 of cases were of nosocomial origin. Examination of the environment revealed the presence of contamination by enteric viruses in 47.8% of cases

A Genome-Wide Association Study Reveals a BDNF-Centered Molecular Network Associated with Alcohol Dependence and Related Clinical Measures

At least 50% of factors predisposing to alcohol dependence (AD) are genetic and women affected with this disorder present with more psychiatric comorbidities, probably indicating different genetic factors involved. We aimed to run a genome-wide association study (GWAS) followed by a bioinformatic functional annotation of associated genomic regions in patients with AD and eight related clinical measures. A genome-wide significant association of rs220677 with AD (p-value = 1.33 × 10−8 calculated with the Yates-corrected χ2 test under the assumption of dominant inheritance) was discovered in female patients. Associations of AD and related clinical measures with seven other single nucleotide polymorphisms listed in previous GWASs of psychiatric and addiction traits were differently replicated in male and female patients. The bioinformatic analysis showed that regulatory elements in the eight associated linkage disequilibrium blocks define the expression of 80 protein-coding genes. Nearly 68% of these and of 120 previously published coding genes associated with alcohol phenotypes directly interact in a single network, where BDNF is the most significant hub gene. This study indicates that several genes behind the pathogenesis of AD are different in male and female patients, but implicated molecular mechanisms are functionally connected. The study also reveals a central role of BDNF in the pathogenesis of AD

International register “Dynamics analysis of comorbidities in SARS-CoV-2 survivors” (AKTIV SARS-CoV-2): analysis of 1,000 patients

COVID-19 is a severe infection with high mortality. The concept of the disease has been shaped to a greater extent on the basis of large registers from the USA, Spain, Italy, and China. However, there is no information on the disease characteristics in Caucasian patients.Therefore, we created an international register with the estimated capacity of 5,000 patients — Dynamics Analysis of Comorbidities in SARS-CoV-2 Survivors (AKTIV SARS-CoV-2), which brought together professionals from the Russian Federation, Republic of Armenia, Republic of Kazakhstan, and Kyrgyz Republic. The article presents the first analysis of the register involving 1,003 patients. It was shown that the most significant difference of the Caucasian population was the higher effect of multimorbidity on the mortality risk vs other registers. More pronounced effect on mortality of such diseases as diabetes, obesity, hypertension, chronic kidney disease, and age over 60 years was also revealed